Healthcare Provider Details

I. General information

NPI: 1801901228
Provider Name (Legal Business Name): KAREN SOTO-MEDINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANATI MEDICAL PLAZA SUITE 206 - #1 JOSE CANDELA ST
MANATI PR
00674
US

IV. Provider business mailing address

#1 JOSE CANDELA ST SUITE 206
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-6744
  • Fax:
Mailing address:
  • Phone: 787-402-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11867
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: