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General NPI Number Information
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NPI Number | 1063080877
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Entity Type | Individual
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Provider Name | RYAN SOTO
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Gender | Male
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 25710 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92354-3874
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Country | US
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Telephone | 909-799-0591
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Fax | 909-799-4421
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Provider Business Mailing Address
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Address Line | 25710 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92354-3874
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Country | US
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Telephone | 909-799-0591
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Fax | 909-799-4421
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 178428
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License Number State | CA
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