Healthcare Provider Details

I. General information

NPI: 1477048726
Provider Name (Legal Business Name): DEYSARI SOTO TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA SUITE 412 CONDOMINIO SAN VICENTE
PONCE PR
00717
US

IV. Provider business mailing address

8169 CALLE CONCORDIA SUITE 412 CONDOMINIO SAN VICENTE
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number86590
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: