Provider Demographics
NPI:1659672186
Name:ZACCHEUS SOTO, CARLOS M (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:ZACCHEUS 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 1:316 CALLE YAGRUMO
Mailing Address - Street 2:FAJARDO GARDENS
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-2967
Mailing Address - Country:US
Mailing Address - Phone:787-655-4808
Mailing Address - Fax:
Practice Address - Street 1:316 CALLE YAGRUMO
Practice Address - Street 2:FAJARDO GARDENS
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-2967
Practice Address - Country:US
Practice Address - Phone:787-655-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18085208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice