MEDICARE: MISS LESLY SOTO CORTES JR. MSW

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	1041C0700X	Clinical Social Worker	22939	PR

General Provider Information

NPI Number	:	1780307124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LESLY SOTO CORTES JR. MSW

Provider Business Mailing Address
First Line	:	HC 5 BOX 10747
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-9761
Country	:	US
Telephone Number	:	787-546-1582
Fax Number	:

Provider Business Practice Location Address
First Line	:	BO CUCHILLA SECTOR LORENZO CARR 444
Second Line	:	KM 1.8 INTERIOR
City	:	MOCA
State	:	PR
Zip	:	00676-9761
Country	:	US
Telephone Number	:	787-546-1582
Fax Number	:

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

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	09/21/2022

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