Provider Demographics
NPI:1225605843
Name:SOTO MALAVE, ELIOMAR SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIOMAR
Middle Name:
Last Name:SOTO MALAVE
Suffix:SR
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:PO BOX 2635
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2635
Mailing Address - Country:US
Mailing Address - Phone:939-213-5717
Mailing Address - Fax:
Practice Address - Street 1:GUAMA TOWN HOUSES C23
Practice Address - Street 2:AVE ENRIGUE J ANGLADE
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:939-213-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty