Provider Demographics
NPI:1679609085
Name:SOTOMAYOR, WANDA L
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:SOTOMAYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6535
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9623
Mailing Address - Country:US
Mailing Address - Phone:787-243-1427
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 6535
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9623
Practice Address - Country:US
Practice Address - Phone:787-243-1427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003626183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician