Provider Demographics
NPI:1407135510
Name:RODRIGUEZ SOTO, JONATHAN (OTL)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:RODRIGUEZ SOTO
Suffix:
Gender:M
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 33234
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9766
Mailing Address - Country:US
Mailing Address - Phone:787-454-6966
Mailing Address - Fax:787-229-8692
Practice Address - Street 1:740 AVE HOSTOS EDIFICIO
Practice Address - Street 2:MEDICAL CENTER PLAZA SUITE 316
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-9766
Practice Address - Country:US
Practice Address - Phone:787-454-6966
Practice Address - Fax:787-229-8692
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1112225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist