Provider Demographics
NPI:1306127642
Name:SOTO REYES, MARTALINA
Entity type:Individual
Prefix:
First Name:MARTALINA
Middle Name:
Last Name:SOTO REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTALINA
Other - Middle Name:
Other - Last Name:SOTO REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:CARR 681
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5313
Mailing Address - Country:US
Mailing Address - Phone:787-201-6771
Mailing Address - Fax:787-881-0508
Practice Address - Street 1:CARR 681 CALLE 1 ISLOTE 2 # 197
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-5313
Practice Address - Country:US
Practice Address - Phone:787-201-6771
Practice Address - Fax:787-881-0508
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR89741041C0700X, 171M00000X
PR1041CO700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2241013OtherLICENCE
PR2241013OtherLICENSE
PR8974OtherSOCIAL WORKER