Healthcare Provider Details

I. General information

NPI: 1043529514
Provider Name (Legal Business Name): LAURA KATHLEEN SOTO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 W VERMONT AVE 104
ESCONDIDO CA
92025-6584
US

IV. Provider business mailing address

474 W VERMONT AVE 104
ESCONDIDO CA
92025-6584
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-9884
  • Fax: 760-432-9953
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: