Provider Demographics
NPI:1538354097
Name:SOTO, CARLOS HUMBERTO (PA)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:HUMBERTO
Last Name:SOTO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR ST SE STE 6600
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-5411
Mailing Address - Country:US
Mailing Address - Phone:505-724-3208
Mailing Address - Fax:505-724-4384
Practice Address - Street 1:201 CEDAR ST SE STE 6600
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5411
Practice Address - Country:US
Practice Address - Phone:505-724-3208
Practice Address - Fax:505-724-4384
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2013-0035363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM92522041Medicaid
NM92522041Medicaid