Provider Demographics
NPI:1548152176
Name:SOTO-RICO, MIGUEL RICARDO
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:RICARDO
Last Name:SOTO-RICO
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 1:3550 CAMINO DEL RIO N STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1740
Mailing Address - Country:US
Mailing Address - Phone:619-756-4095
Mailing Address - Fax:619-514-1026
Practice Address - Street 1:3550 CAMINO DEL RIO N STE 305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1740
Practice Address - Country:US
Practice Address - Phone:619-756-4095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner