MEDICARE: ROXANN RUBY 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	106E00000X	Assistant Behavior Analyst	RBT-23-300530	CA

General Provider Information

NPI Number	:	1386405199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANN RUBY SOTO

Provider Business Mailing Address
First Line	:	1307 GLENNCROSS CT APT 73
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3517
Country	:	US
Telephone Number	:	323-901-1454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 S FREMONT AVE
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-8800
Country	:	US
Telephone Number	:	626-759-9154
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/23/2026

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