MEDICARE: MIRIAM 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1851424105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM SOTO

Provider Business Mailing Address
First Line	:	1072 INDIAN SUMMER CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3352
Country	:	US
Telephone Number	:	831-214-6624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1072 INDIAN SUMMER CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3352
Country	:	US
Telephone Number	:	831-214-6624
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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Directions to “ MIRIAM SOTO ” Practice Location

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