Provider Demographics
NPI:1770219636
Name:SOTO RUIZ, XAVIER (PHD)
Entity Type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:
Last Name:SOTO RUIZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 15000
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9522
Mailing Address - Country:US
Mailing Address - Phone:787-462-5217
Mailing Address - Fax:
Practice Address - Street 1:1034 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1115
Practice Address - Country:US
Practice Address - Phone:787-462-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical