Healthcare Provider Details

I. General information

NPI: 1558287433
Provider Name (Legal Business Name): DEVORA SOTO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PARK AVE STE 120
POMONA CA
91766-1501
US

IV. Provider business mailing address

PO BOX 61
BALDWIN PARK CA
91706-0061
US

V. Phone/Fax

Practice location:
  • Phone: 909-622-3531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: