Provider Demographics
NPI:1578800470
Name:SOTO DE JESUS, NILMARIE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:NILMARIE
Middle Name:
Last Name:SOTO DE JESUS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 645 BOX 6570
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-9742
Mailing Address - Country:US
Mailing Address - Phone:787-243-4548
Mailing Address - Fax:787-250-8347
Practice Address - Street 1:#18 REPARTO ALAMEIN
Practice Address - Street 2:AVE. 65 INFANTERIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:UM
Practice Address - Phone:787-765-9370
Practice Address - Fax:787-250-8347
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist