Provider Demographics
NPI:1063080877
Name:SOTO, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
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 1:25710 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3874
Mailing Address - Country:US
Mailing Address - Phone:909-799-0591
Mailing Address - Fax:909-799-4421
Practice Address - Street 1:25710 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3874
Practice Address - Country:US
Practice Address - Phone:909-799-0591
Practice Address - Fax:909-799-4421
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
CA178428183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No3336C0002XSuppliersPharmacyClinic Pharmacy