Provider Demographics
NPI:1679313118
Name:SOTO, ABRAHAM (DPT)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 ANTON BLVD UNIT 2540
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7164
Mailing Address - Country:US
Mailing Address - Phone:734-747-0718
Mailing Address - Fax:
Practice Address - Street 1:1020 TERMINO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4123
Practice Address - Country:US
Practice Address - Phone:562-433-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist