Healthcare Provider Details

I. General information

NPI: 1548314719
Provider Name (Legal Business Name): CRUZ SOTO & PADILLA, NEFROLOGOS, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB ATENAS HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1662
MANATI PR
00674-1662
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-4120
  • Fax: 787-884-5489
Mailing address:
  • Phone: 787-854-4120
  • Fax: 787-884-5489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MANUEL A. CRUZ-SOTO
Title or Position: ADMINISTRADOR
Credential: M.D.
Phone: 787-854-4120