Provider Demographics
NPI:1437624368
Name:SOTO, LOURDES MABEL (REGISTRED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:MABEL
Last Name:SOTO
Suffix:
Gender:F
Credentials:REGISTRED NURSE
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:M
Other - Last Name:SOTO TRAVERSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNBSN
Mailing Address - Street 1:367 CALLE FORTALEZA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1715
Mailing Address - Country:US
Mailing Address - Phone:787-244-0780
Mailing Address - Fax:787-723-6247
Practice Address - Street 1:900 C CERRA FINAL PARADA 15
Practice Address - Street 2:CDT DR GUALBERTO RABELL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-480-3789
Practice Address - Fax:787-723-6247
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse