Healthcare Provider Details

I. General information

NPI: 1619634086
Provider Name (Legal Business Name): JAQUELINE SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HILLMONT AVE
VENTURA CA
93003-1647
US

IV. Provider business mailing address

2220 SNOW AVE
OXNARD CA
93036-2531
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6729
  • Fax:
Mailing address:
  • Phone: 805-509-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: