1154989036 NPI number — NORA LUCIA SALLS-SOTO

Table of content: NORA LUCIA SALLS-SOTO (NPI 1154989036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154989036 NPI number — NORA LUCIA SALLS-SOTO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALLS-SOTO
Provider First Name:
NORA
Provider Middle Name:
LUCIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154989036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PERLA DEL SUR
Provider Second Line Business Mailing Address:
2623 LAS CARROZAS
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00717-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-432-9588
Provider Business Mailing Address Fax Number:
787-259-8659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE SANTIAGO DE LOS CABALLEROS
Provider Second Line Business Practice Location Address:
CALLE MARGINAL
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-848-4545
Provider Business Practice Location Address Fax Number:
787-259-8659
Provider Enumeration Date:
06/05/2019

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: 163W00000X , with the licence number:  16158 , 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)