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General NPI Number Information
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NPI Number | 1063823813
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Entity Type | Individual
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Provider Name | ISRAEL SOTO
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Gender | Male
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 9441 LBJ FWY STE 602
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City | DALLAS
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State | TX
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Zip | 75243-4545
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Country | US
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Telephone | 214-276-6167
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Fax |
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Provider Business Mailing Address
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Address Line | 14362 COUNTY ROAD 756
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City | SINTON
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State | TX
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Zip | 78387-4335
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Country | US
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Telephone |
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Fax |
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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 | 224ZF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapy Assistant
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License Number | 209773
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License Number State | TX
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