Provider Demographics
NPI:1710957717
Name:SOTO-RUIZ, MANUEL O (MD)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:O
Last Name:SOTO-RUIZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 GRAN BOULEVAR PASEOS
Mailing Address - Street 2:SUITE 112-300
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-285-8093
Mailing Address - Fax:787-285-5209
Practice Address - Street 1:ROSADA MEDICAL BUILDING
Practice Address - Street 2:AVE FONT MARTCLO #358
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-285-8093
Practice Address - Fax:787-285-5209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR10938207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G49561Medicare UPIN
PR89040Medicare ID - Type Unspecified