Healthcare Provider Details

I. General information

NPI: 1265678296
Provider Name (Legal Business Name): MRS. JICELA SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 EAST IMPERIAL HIGHWAY ROOM P-31
DOWNEY CA
90242
US

IV. Provider business mailing address

8526 GRAPE ST
LOS ANGELES CA
90001-4134
US

V. Phone/Fax

Practice location:
  • Phone: 562-940-3694
  • Fax: 562-658-7425
Mailing address:
  • Phone: 323-586-6401
  • Fax: 323-586-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: