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General NPI Number Information
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NPI Number | 1871914390
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Entity Type | Individual
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Provider Name | AMY SOTO
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Gender | Female
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 4550 W OAKEY BLVD STE 111-Q
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City | LAS VEGAS
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State | NV
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Zip | 89102-1581
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Country | US
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Telephone | 702-968-9372
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Fax | 702-932-3189
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Provider Business Mailing Address
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Address Line | 112 BEL PORT DR
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City | LAS VEGAS
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State | NV
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Zip | 89110-4812
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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 | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 172V00000X
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License Number State | NV
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