Provider Demographics
NPI:1689273716
Name:GARCIA SOTO, IVONNE (MS)
Entity Type:Individual
Prefix:MISS
First Name:IVONNE
Middle Name:
Last Name:GARCIA SOTO
Suffix:
Gender:F
Credentials:MS
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 5100 CAJA 8
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-525-6875
Mailing Address - Fax:
Practice Address - Street 1:COAMO PLAZA SHOPPING CENTER CARR. #153 KM. 13.7
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006361103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling