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General NPI Number Information
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NPI Number | 1295357374
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Entity Type | Individual
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Provider Name | DESIRAE SOTTO
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Gender | Female
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 1510 FASHION ISLAND BLVD STE 310
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City | SAN MATEO
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State | CA
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Zip | 94404-1587
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Country | US
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Telephone | 415-650-6128
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Fax |
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Provider Business Mailing Address
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Address Line | 28 SONORA AVE
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-5941
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Country | US
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Telephone | 650-745-6717
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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