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General NPI Number Information
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NPI Number | 1174853261
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Entity Type | Individual
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Provider Name | FERNANDO SOTOCA
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Gender | Male
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | STREET 35 VILLA UNIVERSITARIA BG 11
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City | HUMACAO
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State | PR
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Zip | 00791-4365
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Country | US
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Telephone | 787-349-7276
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Fax |
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Provider Business Mailing Address
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Address Line | URB. VILLA UNIVERSITARIA CALLE 35 BG 11
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-349-7276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 1144
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1701
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License Number State | PR
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