1972689529 NPI number — MRS. IVETTE SOTO TOLEDO PT

Table of content: (NPI 1558186742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972689529 NPI number — MRS. IVETTE SOTO TOLEDO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTO TOLEDO
Provider First Name:
IVETTE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1972689529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00669-0819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-897-6611
Provider Business Mailing Address Fax Number:
787-897-6611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 129 L, 21 HM 9 BO CALLEJONES LARES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00669-0819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-897-6611
Provider Business Practice Location Address Fax Number:
787-897-6611
Provider Enumeration Date:
10/27/2006

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: 225100000X , with the licence number:  1008 , 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: 50053 . This is a "PREFERED MEDICARE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56765 SO . This is a "MEDICARE OPTIMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56765 SO . This is a "MEDICARE SELECTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3304272 . This is a "ACAA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4562405 . This is a "FAMILY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660651790 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: P804 . This is a "FIRST MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6690048 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56765 . This is a "TRIPLE C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870056 . This is a "MEDICARE MUCHO MAS" identifier . This identifiers is of the category "OTHER".




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