Healthcare Provider Details

I. General information

NPI: 1194312827
Provider Name (Legal Business Name): CHRISTIAN JUAREZ SOTO AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN ST
HOUSTON TX
77030-2703
US

IV. Provider business mailing address

6550 FANNIN ST STE 1601
HOUSTON TX
77030-2743
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-3311
  • Fax:
Mailing address:
  • Phone: 713-441-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP145367
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP145367
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: