Provider Demographics
NPI:1659319978
Name:LESLIE I. SOTO VELAZQUEZ
Entity Type:Organization
Organization Name:LESLIE I. SOTO VELAZQUEZ
Other - Org Name:LABORATORIO CLINICO SOTO
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL SUPERVISOR / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:SOTO VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-877-8270
Mailing Address - Street 1:226 BARBOSA ST
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00676
Mailing Address - Country:UM
Mailing Address - Phone:787-877-8270
Mailing Address - Fax:787-877-8270
Practice Address - Street 1:226 BARBOSA ST
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-8270
Practice Address - Fax:787-877-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR423291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031169Medicare PIN