Healthcare Provider Details

I. General information

NPI: 1104451350
Provider Name (Legal Business Name): VICTORIA LYNN SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 W MANCHESTER BLVD
INGLEWOOD CA
90305-2520
US

IV. Provider business mailing address

2504 W MANCHESTER BLVD
INGLEWOOD CA
90305-2520
US

V. Phone/Fax

Practice location:
  • Phone: 323-751-3805
  • Fax:
Mailing address:
  • Phone: 323-751-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: