Provider Demographics
NPI:1053870162
Name:IMELDA D SOTO DDS INC
Entity type:Organization
Organization Name:IMELDA D SOTO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-419-7917
Mailing Address - Street 1:8018 STEWART AND GRAY RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5122
Mailing Address - Country:US
Mailing Address - Phone:562-923-7799
Mailing Address - Fax:
Practice Address - Street 1:8018 STEWART AND GRAY RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5122
Practice Address - Country:US
Practice Address - Phone:562-923-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093991713OtherCMS
ND1093991713OtherNPI ENUMERATOR