=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427610880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIANA SOTO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2019
-----------------------------------------------------
Last Update Date | 10/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1451 AVENIDA ASHFORD
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00907-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-296-9906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2529
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00951-2529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-233-0615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 7761
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------