Healthcare Provider Details

I. General information

NPI: 1487797015
Provider Name (Legal Business Name): SONIA I ROVIRA SOTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 404 KM. 0.1 #126
ANASCO PR
00610
US

IV. Provider business mailing address

PO BOX 2312
ANASCO PR
00610-8312
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-3037
  • Fax: 787-826-3037
Mailing address:
  • Phone: 787-646-6098
  • Fax: 787-265-8278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12291
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: