Healthcare Provider Details

I. General information

NPI: 1942475280
Provider Name (Legal Business Name): SUSAN MARIE SOTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4418
US

IV. Provider business mailing address

1311 N LAFAYETTE ST
DENVER CO
80218-2305
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-3710
  • Fax:
Mailing address:
  • Phone: 303-578-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number46624
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA98543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: