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General NPI Number Information
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NPI Number | 1841308632
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Entity Type | Individual
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Provider Name | ALFREDO JOSE SOTO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 182 SW ACADEMY ST SUITE 30
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City | DALLAS
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State | OR
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Zip | 97338-1922
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Country | US
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Telephone | 503-623-9289
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Fax | 503-831-1726
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Provider Business Mailing Address
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Address Line | 17695 OCEAN BLVD
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City | ROCKAWAY BEACH
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State | OR
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Zip | 97136-9689
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Country | US
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Telephone | 503-548-7363
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD21696
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD21696
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301505995
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License Number State | MI
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