Basic Information
| Provider Information | |||||||||
| NPI: | 1003587858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANAYA-SOTO | ||||||||
| FirstName: | RAYDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 11TH ST NE APT D5 | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338812660 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11650 IBERIA PL STE 130 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921282431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582645858 | ||||||||
| FaxNumber: | 8586496012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2021 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 11040 | FL | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 33037 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.