Healthcare Provider Details

I. General information

NPI: 1114995776
Provider Name (Legal Business Name): RAFAEL SOTO ACEVEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 BLVD LUIS A FERRE
PONCE PR
00717-2113
US

IV. Provider business mailing address

2431 AVE LAS AMERICAS EDIFICIO PORRATA PILA SUITE 102
PONCE PR
00717-2113
US

V. Phone/Fax

Practice location:
  • Phone: 787-234-5386
  • Fax:
Mailing address:
  • Phone: 787-812-2085
  • Fax: 787-812-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12719
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: