Provider Demographics
NPI:1003961392
Name:SOTO, FREDDY VAGAS I
Entity Type:Individual
Prefix:MR
First Name:FREDDY
Middle Name:VAGAS
Last Name:SOTO
Suffix:I
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:URBANIZACION CIBAO CALLE ANGEL FRANCO #8
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00623
Mailing Address - Country:UM
Mailing Address - Phone:787-207-7606
Mailing Address - Fax:787-255-2050
Practice Address - Street 1:38 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4005
Practice Address - Country:US
Practice Address - Phone:787-851-1270
Practice Address - Fax:787-255-2050
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004863183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician