Provider Demographics
NPI:1356497846
Name:SOTO, MARIA MAGDALENA
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MAGDALENA
Last Name: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:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1216
Mailing Address - Country:US
Mailing Address - Phone:787-280-6291
Mailing Address - Fax:787-896-0709
Practice Address - Street 1:26 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2212
Practice Address - Country:US
Practice Address - Phone:787-896-2244
Practice Address - Fax:787-896-0709
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3488OtherPHARMACIST LICENSE