MEDICARE: WILDALIZ SOTO-MORALES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	7062	PR

General Provider Information

NPI Number	:	1093506230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILDALIZ SOTO-MORALES

Provider Business Mailing Address
First Line	:	213 CALLE JOSE C BARBOSA
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-4165
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 192238
Second Line	:	369 CALLE JOSE DE DIEGO LOCAL 103 TORRE MEDICA
City	:	SAN JUAN
State	:	PR
Zip	:	00919-2238
Country	:	US
Telephone Number	:	787-765-6380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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Directions to “ WILDALIZ SOTO-MORALES ” Practice Location

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