MEDICARE: ROXANNA GABRIELA 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	106S00000X	Behavior Technician		NV

General Provider Information

NPI Number	:	1083152599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNA GABRIELA SOTO

Provider Business Mailing Address
First Line	:	4802 STEPHANIE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6132
Country	:	US
Telephone Number	:	818-480-8638
Fax Number	:

Provider Business Practice Location Address
First Line	:	4802 STEPHANIE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6132
Country	:	US
Telephone Number	:	818-480-8638
Fax Number	:

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

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	02/03/2017

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Directions to “ ROXANNA GABRIELA SOTO ” Practice Location

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