Healthcare Provider Details

I. General information

NPI: 1003541442
Provider Name (Legal Business Name): CARLOS ADRIAN VILLANUEVA SOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONACILLO ST., CENTRO MEDICO DE PUERTO RICO
SAN JUAN PR
00926
US

IV. Provider business mailing address

MONACILLO ST., CENTRO MEDICO DE PUERTO RICO
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-248-1328
  • Fax:
Mailing address:
  • Phone: 787-248-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25048
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: