Healthcare Provider Details

I. General information

NPI: 1710320874
Provider Name (Legal Business Name): MINDFUL RHEUMATIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CALLE CESAR GONZALEZ SUITE 101A
SAN JUAN PR
00918-3756
US

IV. Provider business mailing address

576 AVE CESAR GONZALEZ SUITE 101 A
SAN JUAN PR
00918-4299
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-9034
  • Fax: 787-765-1274
Mailing address:
  • Phone: 787-765-9034
  • Fax: 787-765-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number13783
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13816
License Number StatePR

VIII. Authorized Official

Name: DR. OSCAR SOTO-RAICES
Title or Position: RHEUMATOLOGIST
Credential: M.D
Phone: 787-765-9034