Provider Demographics
NPI:1639894660
Name:SOTO CRUZ, ENEMIAS E SR (BSN)
Entity Type:Individual
Prefix:MR
First Name:ENEMIAS
Middle Name:E
Last Name:SOTO CRUZ
Suffix:SR
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLAS DEL PARAISO
Mailing Address - Street 2:APT H148
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-949-7353
Mailing Address - Fax:
Practice Address - Street 1:VILLAS DE PARAISO
Practice Address - Street 2:APT H-148
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-949-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82501163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice