Provider Demographics
NPI:1417487307
Name:SOTO-LOPEZ, GLADYS ODILL (MCR, DCFC)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:ODILL
Last Name:SOTO-LOPEZ
Suffix:
Gender:F
Credentials:MCR, DCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6017 PMB 395
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-6017
Mailing Address - Country:US
Mailing Address - Phone:787-940-3807
Mailing Address - Fax:
Practice Address - Street 1:1735 URB PURPLE TREE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-940-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR785225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor