Healthcare Provider Details

I. General information

NPI: 1063080877
Provider Name (Legal Business Name): RYAN SOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25710 BARTON RD
LOMA LINDA CA
92354-3874
US

IV. Provider business mailing address

25710 BARTON RD
LOMA LINDA CA
92354-3874
US

V. Phone/Fax

Practice location:
  • Phone: 909-799-0591
  • Fax: 909-799-4421
Mailing address:
  • Phone: 909-799-0591
  • Fax: 909-799-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number178428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: