Provider Demographics
NPI:1528849445
Name:SOTO III, EDWARD III
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SOTO III
Suffix:III
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 1:100 N HEARTHSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-0035
Mailing Address - Country:US
Mailing Address - Phone:602-561-9094
Mailing Address - Fax:
Practice Address - Street 1:300 W CLARENDON AVE STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3449
Practice Address - Country:US
Practice Address - Phone:602-282-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health