Healthcare Provider Details

I. General information

NPI: 1235125576
Provider Name (Legal Business Name): EDWIN SOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METROPOLITANO HOSPITAL AVE SAN LUIS
ARECIBO PR
00614-0879
US

IV. Provider business mailing address

PO BOX 140879
ARECIBO PR
00614-0879
US

V. Phone/Fax

Practice location:
  • Phone: 787-643-4120
  • Fax: 787-880-6263
Mailing address:
  • Phone: 787-643-4120
  • Fax: 787-880-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number5275
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: