Healthcare Provider Details

I. General information

NPI: 1952447542
Provider Name (Legal Business Name): MICHELLE MERCEDES MIELES SOTO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANTIGUO HOSPITAL DE DISTRITO 2DO PISO CARR 129
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 9550 COTTO STATION
ARECIBO PR
00613
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-3552
  • Fax: 787-879-8633
Mailing address:
  • Phone: 787-878-3552
  • Fax: 787-879-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8890
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: