Healthcare Provider Details

I. General information

NPI: 1548943285
Provider Name (Legal Business Name): JOHANNA ROMAN SOTO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 64 ESQUINA CALLE #3 URB. INDUSTRIAL ALGARROBOS
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

CARR. 64 ESQUINA CALLE #3 URB. INDUSTRIAL ALGARROBOS
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-838-7272
  • Fax:
Mailing address:
  • Phone: 787-838-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: