Provider Demographics
NPI:1447404769
Name:PORTELA SOTO, JESSICA N (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:N
Last Name:PORTELA SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51502
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1502
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:
Practice Address - Street 1:CARR 4449 KM 1.4 AVE AGUSTIN RAMOS CALERA
Practice Address - Street 2:CIMA ISABELA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17,389208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17389OtherJUNTA DE LIC DE PR