Healthcare Provider Details

I. General information

NPI: 1588718464
Provider Name (Legal Business Name): RAQUEL SOTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BOX 480
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST BOX 480
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-5205
  • Fax: 310-326-7205
Mailing address:
  • Phone: 310-222-5205
  • Fax: 310-326-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: