Healthcare Provider Details

I. General information

NPI: 1114881901
Provider Name (Legal Business Name): CAROL JINAN COSTAS SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 AV. JESUS TORIBIO PINERO
LAS PIEDRAS PR
00771
US

IV. Provider business mailing address

URB. LA RIVIERA CALLE 4 D14
ARROYO PR
00714
US

V. Phone/Fax

Practice location:
  • Phone: 787-347-3673
  • Fax:
Mailing address:
  • Phone: 787-347-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8691
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: