Provider Demographics
NPI:1639959646
Name:DE JESUS SOTO, JUAN ANDRES (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANDRES
Last Name:DE JESUS SOTO
Suffix:
Gender:M
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:URB VILLA MAR
Mailing Address - Street 2:G20 CALLE PACIFICO
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-974-0263
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA MAR
Practice Address - Street 2:G20 CALLE PACIFICO
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-974-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023641208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice