Provider Demographics
NPI:1780349027
Name:SOTO, STEPHANIE MERRY
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MERRY
Last Name:SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BRISAS DEL PLATA
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-5122
Mailing Address - Country:US
Mailing Address - Phone:787-218-3161
Mailing Address - Fax:
Practice Address - Street 1:PR 152 KM. 16.0 CEDRO ARRIBA, MERCADO PLAZA
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR094963163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse