Provider Demographics
NPI:1215923644
Name:SOTO, JANINA (OD)
Entity type:Individual
Prefix:DR
First Name:JANINA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3685
Mailing Address - Country:US
Mailing Address - Phone:760-352-3505
Mailing Address - Fax:760-352-3046
Practice Address - Street 1:2151 ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3685
Practice Address - Country:US
Practice Address - Phone:760-352-3505
Practice Address - Fax:760-352-3046
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9642T174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51380Medicare UPIN
CAWY210Medicare ID - Type Unspecified