Provider Demographics
NPI:1790857563
Name:HOLGUIN SOTO, GEORGE L (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:HOLGUIN SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:L
Other - Last Name:HOLGUIN SOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1269
Mailing Address - Country:US
Mailing Address - Phone:787-869-2626
Mailing Address - Fax:787-869-2624
Practice Address - Street 1:CARR. 152, KM. 9.9
Practice Address - Street 2:BO. CEDRO ARRIBA, SEC. ABANICO
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0000
Practice Address - Country:US
Practice Address - Phone:787-869-2626
Practice Address - Fax:787-869-2624
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12406208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0011037Medicaid
PR0011037Medicaid
PRH83476Medicare UPIN