Provider Demographics
NPI:1861693913
Name:GABRIEL E. SOTO, M.D., INC.
Entity type:Organization
Organization Name:GABRIEL E. SOTO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-273-2525
Mailing Address - Street 1:105 CATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5705
Mailing Address - Country:US
Mailing Address - Phone:530-273-2525
Mailing Address - Fax:530-273-4777
Practice Address - Street 1:105 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5705
Practice Address - Country:US
Practice Address - Phone:530-273-2525
Practice Address - Fax:530-273-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74943207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A749430Medicaid
CAZZZ03314ZMedicare ID - Type Unspecified
CA00A749430Medicaid