=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306710397
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NASHALI IVETTE RODRIGUEZ SOTO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2025
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BO. MACHUELO CARR. #14 ANEXO HOSPITAL PSIQUIATRIA FORENSE PONCE
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-758-8088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 1 BOX 6216
-----------------------------------------------------
City | YAUCO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00698-9741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-259-1845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 17211
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------