Provider Demographics
NPI:1043548613
Name:BARRETO SOTO, HERIBERTO (MD:)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:BARRETO SOTO
Suffix:
Gender:M
Credentials:MD:
Other - Prefix:
Other - First Name:HERIBERTO
Other - Middle Name:
Other - Last Name:BARRETO SOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3223 CALLE PALMA DE MALLORCA
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-8997
Mailing Address - Country:US
Mailing Address - Phone:787-804-3722
Mailing Address - Fax:787-804-3278
Practice Address - Street 1:351 EDIF MEDICAL EMPORIUM STE 209
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-804-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDP804AMedicare PIN