=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649200114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERONICA SOTO-MALDONADO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ROAD #2 KM43.7
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-807-7275
-----------------------------------------------------
Fax | 787-807-7641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 1 BOX 2538
-----------------------------------------------------
City | FLORIDA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00650-9607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-8172
-----------------------------------------------------
Fax | 787-807-7641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 14818
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------