Provider Demographics
NPI:1598344483
Name:SOTO COLON, ANGELICA MARIE
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIE
Last Name:SOTO COLON
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:RD 159 KM 153
Mailing Address - Street 2:BARRIO PUEBLO
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-9442
Mailing Address - Country:US
Mailing Address - Phone:787-859-5439
Mailing Address - Fax:
Practice Address - Street 1:RD 159 KM 153
Practice Address - Street 2:BARRIO PUEBLO
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-9442
Practice Address - Country:US
Practice Address - Phone:787-859-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30121364183700000X
PR13488183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician