Healthcare Provider Details

I. General information

NPI: 1518237536
Provider Name (Legal Business Name): M BERENICE SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA BERENICE GOMEZ-SOTO

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 LENZEN AVE
SAN JOSE CA
95126-6216
US

IV. Provider business mailing address

976 LENZEN AVE
SAN JOSE CA
95126-2737
US

V. Phone/Fax

Practice location:
  • Phone: 408-792-5532
  • Fax: 408-792-5506
Mailing address:
  • Phone: 408-792-5532
  • Fax: 408-792-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number788689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: