Provider Demographics
NPI:1891996682
Name:SOTO-CERVANTES, MELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:
Last Name:SOTO-CERVANTES
Suffix:
Gender:M
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:PO BOX 3891
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3891
Mailing Address - Country:US
Mailing Address - Phone:787-830-7181
Mailing Address - Fax:787-830-7181
Practice Address - Street 1:CARR.# 2 KM.141.1
Practice Address - Street 2:AVE.KENNEDY
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-819-0800
Practice Address - Fax:787-819-0800
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12409208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89591Medicare ID - Type Unspecified