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General NPI Number Information
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NPI Number | 1093591364
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Entity Type | Individual
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Provider Name | ROBERTO ISAI SOTO-GUTIERREZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 3186 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89109-2317
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Country | US
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Telephone | 702-961-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 874 AMERICAN PACIFIC DR
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City | HENDERSON
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State | NV
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Zip | 89014-8800
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Country | US
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Telephone | 702-777-8687
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2941
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License Number State | NV
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