Healthcare Provider Details

I. General information

NPI: 1467522359
Provider Name (Legal Business Name): MARIA PATRICIA SOTO-MINDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EUREKA SQ 129
PACIFICA CA
94044-2654
US

IV. Provider business mailing address

P.O. BOX 742 370 WOODLAND VISTA
LA HONDA CA
94020
US

V. Phone/Fax

Practice location:
  • Phone: 650-569-3300
  • Fax: 650-747-9637
Mailing address:
  • Phone: 650-569-3300
  • Fax: 650-747-9637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: