Healthcare Provider Details

I. General information

NPI: 1992649743
Provider Name (Legal Business Name): MADISON ROSE SOTO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 E PACIFIC COAST HWY STE 230
LONG BEACH CA
90803-4260
US

IV. Provider business mailing address

1123 ELEMENTS WAY
IRVINE CA
92612-6501
US

V. Phone/Fax

Practice location:
  • Phone: 562-512-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: