Provider Demographics
NPI:1477908259
Name:FUENTES-SOTO, JAYSON O (ND)
Entity Type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:O
Last Name:FUENTES-SOTO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0283
Mailing Address - Country:US
Mailing Address - Phone:787-375-0469
Mailing Address - Fax:
Practice Address - Street 1:COMM. BLONDET, CARR. NUM. 3, KM.139, BLOQUE K-26
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00654
Practice Address - Country:US
Practice Address - Phone:787-628-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
PR041202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No171100000XOther Service ProvidersAcupuncturist