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General NPI Number Information
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NPI Number | 1255020244
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Entity Type | Individual
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Provider Name | JUAN SOTO AAC, CPC
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Gender | Male
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 506 W FRANKLIN ST
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City | SHELTON
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State | WA
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Zip | 98584-3517
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Country | US
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Telephone | 360-427-5232
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Fax | 360-427-5006
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Provider Business Mailing Address
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Address Line | PO BOX 59
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City | CHEHALIS
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State | WA
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Zip | 98532-0059
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Country | US
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Telephone | 360-740-4380
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Fax | 360-740-1877
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | CG61438156
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License Number State | WA
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