Provider Demographics
NPI:1093327678
Name:SOTO, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:SOTO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 LONE PINE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5637
Mailing Address - Country:US
Mailing Address - Phone:541-613-3400
Mailing Address - Fax:
Practice Address - Street 1:3552 LONE PINE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5637
Practice Address - Country:US
Practice Address - Phone:541-613-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
ORABA-IN-10254816106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician