Provider Demographics
NPI:1659305167
Name:ORTIZ - SOTO, CARLOS ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ANTONIO
Last Name:ORTIZ - 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:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1280
Mailing Address - Country:US
Mailing Address - Phone:787-255-0303
Mailing Address - Fax:787-357-7473
Practice Address - Street 1:34B CALLE CARBONELL
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3546
Practice Address - Country:US
Practice Address - Phone:787-255-0303
Practice Address - Fax:787-357-7473
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15026208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty