Healthcare Provider Details

I. General information

NPI: 1508541327
Provider Name (Legal Business Name): NICOLLE SOTO MALDONADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LAUREL
BAYAMON PR
00956-4816
US

IV. Provider business mailing address

PO BOX 60327
BAYAMON PR
00960-6032
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5151
  • Fax:
Mailing address:
  • Phone: 787-787-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24546
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: