Healthcare Provider Details

I. General information

NPI: 1477284347
Provider Name (Legal Business Name): DR KELVIN GONZALEZ SOTO PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 03/14/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RD 111 KM 5.0
MOCA PR
00676-4011
US

IV. Provider business mailing address

PO BOX 156
MOCA PR
00676-0156
US

V. Phone/Fax

Practice location:
  • Phone: 787-877-3355
  • Fax: 787-877-3357
Mailing address:
  • Phone: 787-877-3355
  • Fax: 787-877-3357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KELVIN GONZALEZ SOTO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-516-1580