Healthcare Provider Details

I. General information

NPI: 1720123656
Provider Name (Legal Business Name): SONIA M SOTO FONALLEDAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. PARKSIDE CALLE 2 #B-18
GUAYNABO PR
00968
US

IV. Provider business mailing address

URB.PARKSIDE CALLE 2 #B-18
GUAYNABO PR
00968
US

V. Phone/Fax

Practice location:
  • Phone: 787-296-4959
  • Fax: 877-895-0525
Mailing address:
  • Phone: 787-296-4959
  • Fax: 877-895-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15745
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: