Provider Demographics
NPI:1992474100
Name:SOTO, ERIC O
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:O
Last Name:SOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:Y
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0109
Mailing Address - Country:US
Mailing Address - Phone:787-633-7876
Mailing Address - Fax:
Practice Address - Street 1:CALLE AZALEA P536
Practice Address - Street 2:URB. LOIZA VALLEY
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-633-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date: