Healthcare Provider Details

I. General information

NPI: 1780136465
Provider Name (Legal Business Name): JENNIFER SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 02/02/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAPR. PR-2 KM 87.7 INT. PR 130
HATILLO PR
00659
US

IV. Provider business mailing address

152 J RODRIGUEZ IRIZARRY
ARECIBO PR
00617
UM

V. Phone/Fax

Practice location:
  • Phone: 787-680-7852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number011418
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: