Provider Demographics
NPI:1962618389
Name:SOTO SANTIAGO, CESAR (0212B)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:SOTO SANTIAGO
Suffix:
Gender:M
Credentials:0212B
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 1967
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-1967
Mailing Address - Country:US
Mailing Address - Phone:787-383-5723
Mailing Address - Fax:787-825-1120
Practice Address - Street 1:BO.LOS LLANOS CARR.14 KM 26.7
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-1967
Practice Address - Country:US
Practice Address - Phone:787-383-5723
Practice Address - Fax:787-825-1120
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0212B146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0050004Medicare UPIN