Provider Demographics
NPI:1538481841
Name:GONZALEZ SOTO, KELVIN (MD)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:
Last Name:GONZALEZ SOTO
Suffix:
Gender:M
Credentials:MD
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 156
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0156
Mailing Address - Country:US
Mailing Address - Phone:787-877-3355
Mailing Address - Fax:787-877-3357
Practice Address - Street 1:CARR 111 KM 5.0, BO PUEBLO
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0000
Practice Address - Country:US
Practice Address - Phone:787-877-3355
Practice Address - Fax:787-877-3357
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17838208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice