Healthcare Provider Details

I. General information

NPI: 1821964628
Provider Name (Legal Business Name): RAFAEL JEUDIEL SOTO RIVERA PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA SOL DE BORINQUEN CALLE VILLA 139, LOCAL 113
PONCE PR
00730-0563
US

IV. Provider business mailing address

7102 VEREDAS DEL LAUREL
COTO LAUREL PR
00780-3019
US

V. Phone/Fax

Practice location:
  • Phone: 787-629-1444
  • Fax:
Mailing address:
  • Phone: 787-245-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4344
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: