MEDICARE: MRS. DIANE SOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1063688562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE SOTO

Provider Business Mailing Address
First Line	:	6515 ATLANTIC BLVD SUITE A, B, C,
Second Line	:
City	:	BELL
State	:	CA
Zip	:	90201
Country	:	US
Telephone Number	:	323-773-1992
Fax Number	:	323-773-1998

Provider Business Practice Location Address
First Line	:	6515 ATLANTIC AVE
Second Line	:
City	:	BELL
State	:	CA
Zip	:	90201-2521
Country	:	US
Telephone Number	:	323-773-1992
Fax Number	:	323-773-1998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	03/28/2017

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Directions to “ MRS. DIANE SOTO ” Practice Location

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