Provider Demographics
NPI:1629391321
Name:SOTO COLON, TASHA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TASHA MARIE
Middle Name:
Last Name:SOTO COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1953
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1953
Mailing Address - Country:US
Mailing Address - Phone:787-629-3710
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 111 KM 2.4
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0998
Practice Address - Country:US
Practice Address - Phone:787-233-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17760208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice