Provider Demographics
NPI:1356637102
Name:SOTO VELAZQUEZ, MIGDALIA
Entity Type:Individual
Prefix:MRS
First Name:MIGDALIA
Middle Name:
Last Name:SOTO VELAZQUEZ
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:CONSOLIDATE MALL MEDICAL
Mailing Address - Street 2:SUITE C4
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-286-1694
Mailing Address - Fax:
Practice Address - Street 1:CONSOLIDATE MEDICAL MALL
Practice Address - Street 2:SUITE C4
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-286-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist