Healthcare Provider Details

I. General information

NPI: 1396129466
Provider Name (Legal Business Name): FLORA NATALIA SOTO-ENDICOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 CANDELARIA RD NW
ALBUQUERQUE NM
87107-2914
US

IV. Provider business mailing address

2825 CANDELARIA RD NW
ALBUQUERQUE NM
87107-2914
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-8626
  • Fax:
Mailing address:
  • Phone: 505-550-8626
  • Fax: 510-535-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number91436
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11828
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: