Healthcare Provider Details

I. General information

NPI: 1386129625
Provider Name (Legal Business Name): KASSANDRA RENEE SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11037 WARNER AVE # 339
FOUNTAIN VALLEY CA
92708-4007
US

IV. Provider business mailing address

1036 MAGNOLIA ST
BRAWLEY CA
92227-2033
US

V. Phone/Fax

Practice location:
  • Phone: 657-789-2396
  • Fax:
Mailing address:
  • Phone: 760-550-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-86984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: