Provider Demographics
NPI:1982645057
Name:SOTO CRUZ, LEMUEL OMAR (MD)
Entity Type:Individual
Prefix:
First Name:LEMUEL
Middle Name:OMAR
Last Name:SOTO CRUZ
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 2692
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-877-0447
Mailing Address - Fax:787-877-0447
Practice Address - Street 1:CARRETERA 111 INTERSECCION 420 KM 0.2
Practice Address - Street 2:BARRIO VOLADORAS
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-0447
Practice Address - Fax:787-877-0447
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13265208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
00Z0019Medicare ID - Type Unspecified
H35853Medicare UPIN