MEDICARE: CRESENSIA 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	111N00000X	Chiropractor	171556	TX

General Provider Information

NPI Number	:	1376399782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRESENSIA SOTO

Provider Business Mailing Address
First Line	:	PO BOX 690885
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-0885
Country	:	US
Telephone Number	:	210-960-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 690885
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-0885
Country	:	US
Telephone Number	:	210-960-9000
Fax Number	:

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

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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Directions to “ CRESENSIA SOTO ” Practice Location

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