Provider Demographics
NPI:1285229914
Name:SOTO MENDEZ, MIGDALIS
Entity Type:Individual
Prefix:
First Name:MIGDALIS
Middle Name:
Last Name:SOTO MENDEZ
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:HC 4 BOX 18098
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9534
Mailing Address - Country:US
Mailing Address - Phone:787-452-3260
Mailing Address - Fax:
Practice Address - Street 1:CENTER PLEX BUILDING CARR 2
Practice Address - Street 2:KM 133.5 SUITE 103
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-891-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist