Provider Demographics
NPI:1851301782
Name:SOTO, WANDA LIZETTE MALDONADO (MPH OTRL)
Entity Type:Individual
Prefix:MRS
First Name:WANDA LIZETTE
Middle Name:MALDONADO
Last Name:SOTO
Suffix:
Gender:F
Credentials:MPH OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0504
Mailing Address - Country:US
Mailing Address - Phone:787-884-4767
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION FLAMBOYAN A-C14
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-4767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR461225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR62397OtherTRIPLE C INC