Healthcare Provider Details

I. General information

NPI: 1609134105
Provider Name (Legal Business Name): NYDIA Y. DE SOTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NYDIA Y. DE SOTO - CORDERO MD

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRAUMA HOSPITAL ASEM PUERTO RICO MEDICAL CENER BO MONACILLOS
SAN JUAN PR
00935
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3760
  • Fax:
Mailing address:
  • Phone: 787-763-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number19970
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19970
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: