Provider Demographics
NPI:1548609688
Name:SOTO MENDEZ, NORMA I (MSW)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:I
Last Name:SOTO MENDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:I
Other - Last Name:SOTO MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:HC-05 BOX 56308
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-414-0270
Mailing Address - Fax:
Practice Address - Street 1:HC-05 BOX 56308
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-414-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10577320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness