Healthcare Provider Details

I. General information

NPI: 1639605520
Provider Name (Legal Business Name): ANDREA SOTO CADC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 W 19TH ST
SAN PEDRO CA
90731-5314
US

IV. Provider business mailing address

2332 WARMOUTH ST
SAN PEDRO CA
90732-4554
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-8723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII052000218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: