Healthcare Provider Details

I. General information

NPI: 1679403844
Provider Name (Legal Business Name): KRISTA FERNANDA SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 ARLINGTON AVE STE C1
RIVERSIDE CA
92504-1943
US

IV. Provider business mailing address

4512 SUWANNEE ST
RIVERSIDE CA
92501-1512
US

V. Phone/Fax

Practice location:
  • Phone: 951-977-8635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: