MEDICARE: TASHA LYNN SOUTER MD

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	2084P0800X	Psychiatry Physician	A72996	CA

General Provider Information

NPI Number	:	1831206697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA LYNN SOUTER MD

Provider Business Mailing Address
First Line	:	1950 ALAMEDA DE LAS PULGAS
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-1222
Country	:	US
Telephone Number	:	650-208-0098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 ALAMEDA DE LAS PULGAS
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-1222
Country	:	US
Telephone Number	:	650-208-0098
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	01/26/2021

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