Healthcare Provider Details

I. General information

NPI: 1902723513
Provider Name (Legal Business Name): JULISSA SOTO CANALES
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: JULISSA SOTO

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

6636 JOSE LEON DR
EL PASO TX
79932-2215
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number89849
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: