Provider Demographics
NPI:1851386338
Name:SOTO-GOITIA, MAYRA LUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:LUZ
Last Name:SOTO-GOITIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53-11 CALLE 48
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4423
Mailing Address - Country:US
Mailing Address - Phone:787-281-2255
Mailing Address - Fax:787-753-0309
Practice Address - Street 1:CALLE CESAR GONZALEZ #462
Practice Address - Street 2:URB ROOSEVELT
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-281-2255
Practice Address - Fax:787-753-0309
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15567207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH87001Medicare UPIN
PR0023217Medicare PIN