Provider Demographics
NPI:1346387909
Name:CABAN SOTO, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:CABAN SOTO
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 1:107 CALLE N
Mailing Address - Street 2:RAMEY BASE
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-1405
Mailing Address - Country:US
Mailing Address - Phone:787-890-0075
Mailing Address - Fax:
Practice Address - Street 1:107 CALLE N
Practice Address - Street 2:RAMEY BASE
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-1405
Practice Address - Country:US
Practice Address - Phone:787-890-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14958208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-02092Medicare UPIN
PR0022280Medicare ID - Type Unspecified