Healthcare Provider Details

I. General information

NPI: 1780332734
Provider Name (Legal Business Name): AYELETT SOTO BA, SOCIOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

IV. Provider business mailing address

2155 CHICAGO AVE STE 203
RIVERSIDE CA
92507-2209
US

V. Phone/Fax

Practice location:
  • Phone: 951-530-5900
  • Fax: 951-530-5945
Mailing address:
  • Phone: 951-357-6926
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: