Provider Demographics
NPI:1144067612
Name:SOTO, REESE KILEY
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:KILEY
Last Name:SOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 CLEARVIEW DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5891
Mailing Address - Country:US
Mailing Address - Phone:408-767-0803
Mailing Address - Fax:
Practice Address - Street 1:1835 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1629
Practice Address - Country:US
Practice Address - Phone:408-885-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health