Healthcare Provider Details

I. General information

NPI: 1851312284
Provider Name (Legal Business Name): VERONICA SOTO RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CREEK RD
IRVINE CA
92604-4724
US

IV. Provider business mailing address

35 CREEK RD
IRVINE CA
92604-4724
US

V. Phone/Fax

Practice location:
  • Phone: 949-297-3838
  • Fax: 949-297-3839
Mailing address:
  • Phone: 949-297-3838
  • Fax: 949-297-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0109191
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: