Provider Demographics
NPI:1689669335
Name:SOTO, OMAR (RPT)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:RPT
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 3161
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3161
Mailing Address - Country:US
Mailing Address - Phone:787-882-6677
Mailing Address - Fax:787-882-6677
Practice Address - Street 1:124.7 KM #2 ST PUNTO DE ORO BUILDING
Practice Address - Street 2:BO CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-6677
Practice Address - Fax:787-882-6677
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ44695Medicare UPIN
PR0057250Medicare ID - Type UnspecifiedPROVIDER NUMBER