Provider Demographics
NPI:1568938363
Name:SOTO-HERNANDEZ, YARITZA
Entity Type:Individual
Prefix:
First Name:YARITZA
Middle Name:
Last Name:SOTO-HERNANDEZ
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 1:100 AVE LAUREL
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4816
Mailing Address - Country:US
Mailing Address - Phone:787-798-3001
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 BAYAMON MEDICAL PLAZA
Practice Address - Street 2:SUITE 505
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-876-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
PR22623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRNONEOtherSTUDENT