Healthcare Provider Details

I. General information

NPI: 1861693913
Provider Name (Legal Business Name): GABRIEL E. SOTO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CATHERINE LN
GRASS VALLEY CA
95945-5705
US

IV. Provider business mailing address

105 CATHERINE LN
GRASS VALLEY CA
95945-5705
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-2525
  • Fax: 530-273-4777
Mailing address:
  • Phone: 530-273-2525
  • Fax: 530-273-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA74943
License Number StateCA

VIII. Authorized Official

Name: DR. GABRIEL E. SOTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-273-2525