Healthcare Provider Details

I. General information

NPI: 1689788754
Provider Name (Legal Business Name): ELAINE SOTO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 SPAIN RD NE STE E
ALBUQUERQUE NM
87111-1895
US

IV. Provider business mailing address

PO BOX 14926
ALBUQUERQUE NM
87191-4926
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-9004
  • Fax: 505-323-9004
Mailing address:
  • Phone: 505-323-9004
  • Fax: 505-323-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0893
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: