Provider Demographics
NPI:1124435250
Name:SOTO-ALVAREZ, SERGIO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:SOTO-ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:SOTO-ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT 118670
Mailing Address - Street 1:1202 MORENA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3844
Mailing Address - Country:US
Mailing Address - Phone:619-275-0822
Mailing Address - Fax:
Practice Address - Street 1:286 EUCLID AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3611
Practice Address - Country:US
Practice Address - Phone:619-859-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106H00000X, 390200000X
CA143464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program