Healthcare Provider Details

I. General information

NPI: 1265337547
Provider Name (Legal Business Name): EDWIN GEOVANY SORTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 INDIAN PAINTBRUSH RD
ADELANTO CA
92301-4265
US

IV. Provider business mailing address

16600 SHERMAN WAY STE 178
VAN NUYS CA
91406-3875
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-5728
  • Fax:
Mailing address:
  • Phone: 818-235-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: