Healthcare Provider Details

I. General information

NPI: 1710912746
Provider Name (Legal Business Name): DR SYLVIA ANA SOTO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/31/2007
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: 325-653-6422
Mailing address:
  • Phone: 325-486-9468
  • Fax: 325-653-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SYLVIA ANA SOTO
Title or Position: OWNER
Credential: PHD
Phone: 325-486-9468