Provider Demographics
NPI:1528793700
Name:PRISCILLA M SOTO JUSTINIANO LLC
Entity type:Organization
Organization Name:PRISCILLA M SOTO JUSTINIANO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOTO JUSTINIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-860-2543
Mailing Address - Street 1:PO BOX 2114
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-2114
Mailing Address - Country:US
Mailing Address - Phone:985-860-2543
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE JULIO VICTOR NUNEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1912
Practice Address - Country:US
Practice Address - Phone:787-873-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty