Healthcare Provider Details

I. General information

NPI: 1619984036
Provider Name (Legal Business Name): VICENTE JUAN URBISTONDO SOTO AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA ASPS(126)
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

PO BOX 270454
SAN JUAN PR
00928-2454
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-0654
Mailing address:
  • Phone: 787-641-7582
  • Fax: 787-641-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number266
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: