Healthcare Provider Details

I. General information

NPI: 1366360877
Provider Name (Legal Business Name): EVELYN ALEJANDRA SOLTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MAGNOLIA AVE
EL CAJON CA
92020-4524
US

IV. Provider business mailing address

3244 KEMPF ST
LEMON GROVE CA
91945-2512
US

V. Phone/Fax

Practice location:
  • Phone: 619-924-4205
  • Fax:
Mailing address:
  • Phone: 562-479-3417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number722931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: