1447404769 NPI number — DR. JESSICA N. PORTELA SOTO M.D.

Table of content: DR. JESSICA N. PORTELA SOTO M.D. (NPI 1447404769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447404769 NPI number — DR. JESSICA N. PORTELA SOTO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTELA SOTO
Provider First Name:
JESSICA
Provider Middle Name:
N.
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:
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:
1447404769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51502
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00950-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-710-2532
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 4449 KM 1.4 AVE AGUSTIN RAMOS CALERA
Provider Second Line Business Practice Location Address:
CIMA ISABELA
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-710-2532
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2008

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: 208D00000X , with the licence number:  17,389 , 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: 17389 . This is a "JUNTA DE LIC DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".