MEDICARE: M BERENICE 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	163WC1500X	Community Health Registered Nurse	788689	CA

General Provider Information

NPI Number	:	1518237536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M BERENICE SOTO

Provider Business Mailing Address
First Line	:	976 LENZEN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2737
Country	:	US
Telephone Number	:	408-792-5532
Fax Number	:	408-792-5506

Provider Business Practice Location Address
First Line	:	976 LENZEN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-6216
Country	:	US
Telephone Number	:	408-792-5532
Fax Number	:	408-792-5506

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

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	08/13/2012

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Directions to “ M BERENICE SOTO ” Practice Location

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