MEDICARE: RAFAEL SOTO M.D.

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	208D00000X	General Practice Physician	13921	PR

General Provider Information

NPI Number	:	1932105665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL SOTO M.D.

Provider Business Mailing Address
First Line	:	PMB 167 CARR 693
Second Line	:	425 SUITE 1
City	:	DORADO
State	:	PR
Zip	:	00646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVE. BOULEVARD # 3326
Second Line	:	3RA SECC LEVITTOWN
City	:	TOA BAJA
State	:	PR
Zip	:	00949
Country	:	US
Telephone Number	:	787-784-7200
Fax Number	:	787-261-9090

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	12/30/2016

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