Provider Demographics
NPI:1972647030
Name:GRAJALES-SOTO, MARITZA E (MT)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:E
Last Name:GRAJALES-SOTO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 AVE MAGDALENA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1728
Mailing Address - Country:US
Mailing Address - Phone:787-667-1902
Mailing Address - Fax:787-257-8490
Practice Address - Street 1:33 # 17, AVE. ROBERTO CLEMENTE
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-8349
Practice Address - Fax:787-254-8490
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1759246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management