Individual provider Active NPI

Ivan Fernando Soto

  • Marriage & Family Therapist
  • Pasadena, CA
National Provider Identifier
1013219773
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
IMF94490 Issued in CA
Practice address
210 S de Lacey Ave Ste 110
Pasadena, CA 91105-2074
Phone
(626) 395-7100
NPI assigned
Nov 30, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X IMF94490 CA Primary

Addresses

Primary practice location

210 S de Lacey Ave Ste 110
Pasadena, CA 91105-2074

Mailing address

210 S de Lacey Ave Ste 110
Pasadena, CA 91105-2074
Phone (626) 395-7100

Other practice location 1

21545 Centre Pointe Pkwy
Santa Clarita, CA 91350-2947
Phone (661) 255-6847 ext. 3145

Other practice location 2

21545 Centre Pointe Pkwy
Santa Clarita, CA 91350-2947
Phone (661) 255-6847 ext. 3145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
IMF94490CAMDMarriage & Family Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1013219773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S DE LACEY AVE STE 110",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052074",
            "telephone_number": "626-395-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S DE LACEY AVE STE 110",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052074",
            "telephone_number": "626-395-7100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21545 Centre Pointe Pkwy",
            "address_purpose": "LOCATION",
            "city": "Santa Clarita",
            "state": "CA",
            "postal_code": "913502947",
            "country_code": "US",
            "telephone_number": "661-255-6847 x3145",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21545 Centre Pointe Pkwy",
            "address_purpose": "LOCATION",
            "city": "Santa Clarita",
            "state": "CA",
            "postal_code": "913502947",
            "country_code": "US",
            "telephone_number": "661-255-6847 x3145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOTO",
        "first_name": "IVAN",
        "middle_name": "FERNANDO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-30",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF94490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.