MEDICARE: KASSANDRA RENEE 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	103K00000X	Behavior Analyst	1-26-86984	CA

General Provider Information

NPI Number	:	1386129625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA RENEE SOTO

Provider Business Mailing Address
First Line	:	1036 MAGNOLIA ST
Second Line	:
City	:	BRAWLEY
State	:	CA
Zip	:	92227-2033
Country	:	US
Telephone Number	:	760-550-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	1649 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2746
Country	:	US
Telephone Number	:	212-481-4040
Fax Number	:

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

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	02/05/2026

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