Provider Demographics
NPI:1407014756
Name:SOTO, GRISELY (OD)
Entity Type:Individual
Prefix:
First Name:GRISELY
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5702
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-9403
Mailing Address - Country:US
Mailing Address - Phone:787-810-3437
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 5702
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-9403
Practice Address - Country:US
Practice Address - Phone:787-810-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist