Healthcare Provider Details

I. General information

NPI: 1902820137
Provider Name (Legal Business Name): CLOTILDE SOTO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

IV. Provider business mailing address

PARQUE MONTERREY 1 ST.110 APT 103
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax: 787-651-4311
Mailing address:
  • Phone: 787-840-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3293
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: