Healthcare Provider Details

I. General information

NPI: 1366361909
Provider Name (Legal Business Name): IVELISSE SOTO LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CALLE SANTA CRUZ
BAYAMON PR
00961-7052
US

IV. Provider business mailing address

1831 AVE PALACIOS DE VERSALLES
TOA ALTA PR
00953-6004
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5364
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: