Provider Demographics
NPI:1689807968
Name:CARCORZE SOTO, LUIS DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:DANIEL
Last Name:CARCORZE 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:URB EUGENIO MARIA DE HOSTOS
Mailing Address - Street 2:2 AVE LOS MAESTROS
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:787-951-7074
Mailing Address - Fax:
Practice Address - Street 1:EDIF LA PALMA
Practice Address - Street 2:ESQ DE DIEGO SUITE 1C
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4861
Practice Address - Country:US
Practice Address - Phone:787-986-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18625208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18625OtherLICENCIA MEDICO PUERTO RICO
DCFC4510005OtherDEA