Healthcare Provider Details

I. General information

NPI: 1609583202
Provider Name (Legal Business Name): KEVIN SOTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 LAKEVIEW DR
CROSS JUNCTION VA
22625-2421
US

IV. Provider business mailing address

236 LAKEVIEW DR
CROSS JUNCTION VA
22625-2421
US

V. Phone/Fax

Practice location:
  • Phone: 571-271-6297
  • Fax:
Mailing address:
  • Phone: 571-271-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: