Healthcare Provider Details

I. General information

NPI: 1184679763
Provider Name (Legal Business Name): SYLVIA A SOTO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W CONCHO AVE
SAN ANGELO TX
76903-6310
US

IV. Provider business mailing address

411 W CONCHO AVE
SAN ANGELO TX
76903-6310
US

V. Phone/Fax

Practice location:
  • Phone: 325-486-9468
  • Fax:
Mailing address:
  • Phone: 325-486-9468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number31147
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: