Healthcare Provider Details

I. General information

NPI: 1023986296
Provider Name (Legal Business Name): DR. RYAN SOTTO SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 E J ST
CHULA VISTA CA
91910-6115
US

IV. Provider business mailing address

84 E J ST
CHULA VISTA CA
91910-6115
US

V. Phone/Fax

Practice location:
  • Phone: 619-425-9600
  • Fax:
Mailing address:
  • Phone: 619-425-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: