Provider Demographics
NPI:1659555662
Name:MILDRED E. SOTO AGUILAR
Entity Type:Organization
Organization Name:MILDRED E. SOTO AGUILAR
Other - Org Name:EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTIAGO COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:787-854-6222
Mailing Address - Street 1:ROAD 149 NUMBER 10
Mailing Address - Street 2:SUITE 255
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-6222
Mailing Address - Fax:787-854-6660
Practice Address - Street 1:ROAD 149 NUMBER 10
Practice Address - Street 2:SUITE 255
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-6222
Practice Address - Fax:787-854-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR434261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58683Medicare PIN