Healthcare Provider Details

I. General information

NPI: 1497865299
Provider Name (Legal Business Name): ASTRID DE LOS A. SOTOMAYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CALLE CONCEPCION VERA
MOCA PR
00676-4813
US

IV. Provider business mailing address

PO BOX 152
MOCA PR
00676-0152
US

V. Phone/Fax

Practice location:
  • Phone: 787-877-0110
  • Fax: 787-818-0110
Mailing address:
  • Phone: 787-877-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3990
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: