Provider Demographics
NPI:1114995776
Name:SOTO ACEVEDO, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:SOTO ACEVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 AVE LAS AMERICAS
Mailing Address - Street 2:EDIFICIO PORRATA PILA SUITE 102
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2113
Mailing Address - Country:US
Mailing Address - Phone:787-812-2085
Mailing Address - Fax:787-812-2088
Practice Address - Street 1:2431 BLVD LUIS A FERRE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-234-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12719208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR061125OtherCRUZ AZUL DE PUERTO RICO
PRPE3846OtherPALIC
PR203492OtherPREFERRED HEALTH
PR660564409OtherCIGNA
PR7310338OtherHUMANA
PR1898OtherAMERICAN HEALTH
PR90243OtherTRIPLE SSS
PR7310338OtherHUMANA
PR0090243Medicare ID - Type Unspecified