Provider Demographics
NPI:1275820953
Name:GONZALEZ-SOTO, YADIRA ENID
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:ENID
Last Name:GONZALEZ-SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 CARR 2
Mailing Address - Street 2:WALGREENS DRUG STORE 00710 DRIVE IN PLAZA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5240
Mailing Address - Country:US
Mailing Address - Phone:787-785-9176
Mailing Address - Fax:787-785-9223
Practice Address - Street 1:2135 CARR 2
Practice Address - Street 2:WALGREENS DRUG STORE 00710 DRIVE IN PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5240
Practice Address - Country:US
Practice Address - Phone:787-785-9176
Practice Address - Fax:787-785-9223
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist