Provider Demographics
NPI:1871704981
Name:SOTO, ANTONIO (NURSE)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 105 BARRIO VILLA ANGELICA
Mailing Address - Street 2:SAN IGNACIO 337
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-832-2391
Mailing Address - Fax:787-833-1371
Practice Address - Street 1:CENTRO SALUD MENTAL DE MAYAGUEZ
Practice Address - Street 2:410 AVE HOSTOS SUITE 7
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-833-2193
Practice Address - Fax:787-833-1371
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1349163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical