Provider Demographics
NPI:1609134105
Name:DE SOTO, NYDIA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:Y
Last Name:DE SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NYDIA
Other - Middle Name:Y
Other - Last Name:DE SOTO - CORDERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 365067
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-763-2440
Mailing Address - Fax:
Practice Address - Street 1:TRAUMA HOSPITAL ASEM
Practice Address - Street 2:PUERTO RICO MEDICAL CENER BO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-777-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR199702086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery