Provider Demographics
NPI:1497865299
Name:SOTOMAYOR, ASTRID DE LOS A
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:DE LOS A
Last Name:SOTOMAYOR
Suffix:
Gender:F
Credentials:
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 152
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0152
Mailing Address - Country:US
Mailing Address - Phone:787-877-4516
Mailing Address - Fax:
Practice Address - Street 1:124 CALLE CONCEPCION VERA
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4813
Practice Address - Country:US
Practice Address - Phone:787-877-0110
Practice Address - Fax:787-818-0110
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3990183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician