Individual
GLENN SOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
290 I O O F AVE, GILROY, CA 95020-5204
(408) 846-2100
Mailing address
871 GHARKEY ST, SANTA CRUZ, CA 95060-5925
(831) 469-3257
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XDM432A68394
BLUE CROSS HMO MEMBER ID
CA
Enumeration date
11/29/2006
Last updated
07/08/2007
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