Healthcare Provider Details

I. General information

NPI: 1427268770
Provider Name (Legal Business Name): MARIA DE LOURDES MARIN SOTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CALLE LOAIZA CORDERO
SAN JUAN PR
00918-3325
US

IV. Provider business mailing address

PO BOX 1756
TRUJILLO ALTO PR
00977-1756
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-2874
  • Fax:
Mailing address:
  • Phone: 787-761-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number8731
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: