1265516660 NPI number — DR. MELBA SOTOMAYOR M.D.

Table of content: DR. MELBA SOTOMAYOR M.D. (NPI 1265516660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265516660 NPI number — DR. MELBA SOTOMAYOR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTOMAYOR
Provider First Name:
MELBA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOTOMAYOR
Provider Other First Name:
MELBA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.,
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265516660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AGUADILLA MEDICAL PLAZA
Provider Second Line Business Mailing Address:
AVENIDA SEVERIANO CUEVAS 24 SUITE 201
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-880-7380
Provider Business Mailing Address Fax Number:
787-997-2090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 AVE SEVERIANO CUEVAS
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603-5762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-882-7380
Provider Business Practice Location Address Fax Number:
787-997-2090
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  7416 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28719 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3637 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 601421 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8000075 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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