Healthcare Provider Details

I. General information

NPI: 1437624368
Provider Name (Legal Business Name): LOURDES MABEL SOTO REGISTRED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOURDES M. SOTO TRAVERSO RNBSN

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 C CERRA FINAL PARADA 15 CDT DR GUALBERTO RABELL
SAN JUAN PR
00928
US

IV. Provider business mailing address

367 CALLE FORTALEZA
SAN JUAN PR
00901-1715
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3789
  • Fax: 787-723-6247
Mailing address:
  • Phone: 787-244-0780
  • Fax: 787-723-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number18541
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: