1972689529 NPI number — MRS. IVETTE SOTO TOLEDO PT

Table of content: MRS. IVETTE SOTO TOLEDO PT (NPI 1972689529)

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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