Healthcare Provider Details

I. General information

NPI: 1417423773
Provider Name (Legal Business Name): JUAN G SOTO VALERA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 23RD ST FL 34950
FORT PIERCE FL
34950-4803
US

IV. Provider business mailing address

T17 CALLE 17 LEVITTOWN URB LAGOS DE PLATA
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 772-461-4000
  • Fax:
Mailing address:
  • Phone: 787-674-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number124300
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11002086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: