Healthcare Provider Details

I. General information

NPI: 1972419653
Provider Name (Legal Business Name): MARISSA SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 W 154TH ST
LAWNDALE CA
90260-1740
US

IV. Provider business mailing address

16700 YUKON AVE APT 113
TORRANCE CA
90504-1321
US

V. Phone/Fax

Practice location:
  • Phone: 310-676-0197
  • Fax:
Mailing address:
  • Phone: 310-676-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number31706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: