Provider Demographics
NPI:1447700778
Name:SOTO, REINALDO
Entity type:Individual
Prefix:
First Name:REINALDO
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 1:8711 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5418
Mailing Address - Country:US
Mailing Address - Phone:830-569-1104
Mailing Address - Fax:830-569-1107
Practice Address - Street 1:220 W GOODWIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4115
Practice Address - Country:US
Practice Address - Phone:830-569-1104
Practice Address - Fax:830-569-1107
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX538807YKRCMedicare PIN