Healthcare Provider Details

I. General information

NPI: 1275402935
Provider Name (Legal Business Name): WILMARY RAMOS SOTO LCDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND BELAIR # MANGO174
GUAYNABO PR
00968-4401
US

IV. Provider business mailing address

COND BELAIR # MANGO174
GUAYNABO PR
00968-4401
US

V. Phone/Fax

Practice location:
  • Phone: 787-349-1589
  • Fax:
Mailing address:
  • Phone: 787-349-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8514
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: