Provider Demographics
NPI:1710320874
Name:MINDFUL RHEUMATIX LLC
Entity Type:Organization
Organization Name:MINDFUL RHEUMATIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RHEUMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO-RAICES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-765-9034
Mailing Address - Street 1:576 AVE CESAR GONZALEZ
Mailing Address - Street 2:SUITE 101 A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4299
Mailing Address - Country:US
Mailing Address - Phone:787-765-9034
Mailing Address - Fax:787-765-1274
Practice Address - Street 1:576 CALLE CESAR GONZALEZ
Practice Address - Street 2:SUITE 101A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3756
Practice Address - Country:US
Practice Address - Phone:787-765-9034
Practice Address - Fax:787-765-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13783207RR0500X
PR138162084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1962441717Medicare PIN
PR1598986747Medicare PIN