Healthcare Provider Details

I. General information

NPI: 1275622284
Provider Name (Legal Business Name): ANTONIO GUILLERMO SOTOMAYOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MAGA H. PSIQUIATRICO RIO PIDRAS BO MONACILLOS
SAN JUAN PR
00922
US

IV. Provider business mailing address

PO BOX 22402 UPR STATION
SAN JUAN PR
00931-2402
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-4646
  • Fax:
Mailing address:
  • Phone: 787-792-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number6099
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: