Provider Demographics
NPI:1316901374
Name:MIRO SOTOMAYOR, PEDRO A (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:A
Last Name:MIRO SOTOMAYOR
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 336450
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-6450
Mailing Address - Country:US
Mailing Address - Phone:787-844-6669
Mailing Address - Fax:787-844-6888
Practice Address - Street 1:450 FERROCARRIL STREET
Practice Address - Street 2:SUITE 302 SANTA MARIA MEDICAL BUILDING
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1105
Practice Address - Country:US
Practice Address - Phone:787-844-7027
Practice Address - Fax:787-844-6888
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2683207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1316901374OtherNPI
PR1316901374OtherNPI
PR84966BMedicare PIN