Provider Demographics
NPI:1003541442
Name:VILLANUEVA SOTO, CARLOS ADRIAN
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ADRIAN
Last Name:VILLANUEVA SOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 7 BOX 32568
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9604
Mailing Address - Country:US
Mailing Address - Phone:787-248-1328
Mailing Address - Fax:
Practice Address - Street 1:CARR #129 BO. CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-9604
Practice Address - Country:US
Practice Address - Phone:787-248-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program