Provider Demographics
NPI:1861732448
Name:SOTO, JAVIER JR
Entity type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:
Last Name:SOTO
Suffix:JR
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 1:16979 S DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3011
Mailing Address - Country:US
Mailing Address - Phone:424-757-2818
Mailing Address - Fax:
Practice Address - Street 1:500 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3225
Practice Address - Country:US
Practice Address - Phone:310-516-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC6181212101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)