Provider Demographics
NPI:1124115001
Name:SOTO, SANDRA VIOLETA (MD)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:VIOLETA
Last Name:SOTO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:145 CALLE CIELO RUBI
Mailing Address - Street 2:URBANIZACION CIELO DORADO VILLEGE
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0000
Mailing Address - Country:US
Mailing Address - Phone:787-794-1497
Mailing Address - Fax:787-794-1497
Practice Address - Street 1:77 CALLE BRUNO CRUZ
Practice Address - Street 2:LOCAL NUM 1
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-2443
Practice Address - Country:US
Practice Address - Phone:787-794-1497
Practice Address - Fax:787-794-1497
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-01-15
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Provider Licenses
StateLicense IDTaxonomies
PR16596208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0025058Medicare PIN
PRI69987Medicare UPIN