Provider Demographics
NPI:1154383727
Name:SOTO GONZALEZ, EDWIN D (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:D
Last Name:SOTO GONZALEZ
Suffix:
Gender:M
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 250437
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0437
Mailing Address - Country:US
Mailing Address - Phone:787-891-5130
Mailing Address - Fax:787-891-5130
Practice Address - Street 1:2053 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:#3
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-5130
Practice Address - Fax:787-891-5130
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8016208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29472Medicare ID - Type Unspecified
E63389Medicare UPIN