Healthcare Provider Details

I. General information

NPI: 1932739125
Provider Name (Legal Business Name): ALEXIS SOTO HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CALLE PAVIA FERNANDEZ
SAN SEBASTIAN PR
00685-2285
US

IV. Provider business mailing address

HC 5 BOX 107490
MOCA PR
00676-9761
US

V. Phone/Fax

Practice location:
  • Phone: 939-386-1455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22944
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: