Healthcare Provider Details

I. General information

NPI: 1629720578
Provider Name (Legal Business Name): GEIA SOTTO DAVIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 GATEWAY DR STE 100
RIVERSIDE CA
92507-0908
US

IV. Provider business mailing address

2799 GATEWAY DR STE 100
RIVERSIDE CA
92507-0908
US

V. Phone/Fax

Practice location:
  • Phone: 833-450-5957
  • Fax: 833-450-5967
Mailing address:
  • Phone: 833-450-5967
  • Fax: 833-450-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: