1154383727 NPI number — EDWIN D SOTO GONZALEZ MD

Table of content: EDWIN D SOTO GONZALEZ MD (NPI 1154383727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154383727 NPI number — EDWIN D SOTO GONZALEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTO GONZALEZ
Provider First Name:
EDWIN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1154383727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250437
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00604-0437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-891-5130
Provider Business Mailing Address Fax Number:
787-891-5130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2053 AVE PEDRO ALBIZU CAMPOS
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-891-5130
Provider Business Practice Location Address Fax Number:
787-891-5130
Provider Enumeration Date:
04/06/2006

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: 208D00000X , with the licence number:  8016 , 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)





Copyright © 2007-2025 www.npivalidator.com