Healthcare Provider Details

I. General information

NPI: 1376271759
Provider Name (Legal Business Name): DANIEL A. SOTO LOPEZ MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 1, AVE. SAKURA, BAIROA, VILLA BLANCA INDUSTRIAL PARK SEGUNDO PISO, SUITE 235
CAGUAS PR
00725-2036
US

IV. Provider business mailing address

PO BOX 536
CAGUAS PR
00726-0536
US

V. Phone/Fax

Practice location:
  • Phone: 787-705-5565
  • Fax:
Mailing address:
  • Phone: 787-705-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8919
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: