MEDICARE: DR. CYNTHIA JASA SOTO M.D.

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	2084N0400X	Neurology Physician	101239	CA

General Provider Information

NPI Number	:	1619161049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA JASA SOTO M.D.

Provider Business Mailing Address
First Line	:	399 E HIGHLAND AVE STE 223
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-3864
Country	:	US
Telephone Number	:	909-475-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	399 E HIGHLAND AVE STE 223
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-3864
Country	:	US
Telephone Number	:	909-475-5200
Fax Number	:

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	09/30/2008

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