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NPI Code Detail

MEDICARE: RAUL JESUS SOTO

MEDICARE: RAUL JESUS 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
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1101YA0400XOTHERCASUBSTANCE ABUSE COUNSELING

General Provider Information

NPI Number : 1740798628
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAUL JESUS SOTO
Provider Business Mailing Address
First Line : 102 S 11TH ST
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-2132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1659 SCOTT BLVD STE 30
Second Line :
City : SANTA CLARA
State : CA
Zip : 95050-4137
Country : US
Telephone Number : 408-998-5242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2018
Last Update Date : 01/13/2018

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Directions to “ RAUL JESUS SOTO ” Practice Location

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