Healthcare Provider Details

I. General information

NPI: 1790613370
Provider Name (Legal Business Name): ALEJANDRO PEREZ SOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S AIRPORT WAY
MANTECA CA
95337-8426
US

IV. Provider business mailing address

1689 MERIDIAN DR
STOCKTON CA
95206-2893
US

V. Phone/Fax

Practice location:
  • Phone: 209-456-5805
  • Fax:
Mailing address:
  • Phone: 209-390-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN758618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: