Healthcare Provider Details

I. General information

NPI: 1396502431
Provider Name (Legal Business Name): SCARLETT RUBY SANTOS SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST
BOSTON MA
02114-3117
US

IV. Provider business mailing address

226 FIELD ST
NEW BEDFORD MA
02740-2133
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2377418
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN10001917
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: