Provider Demographics
NPI:1093506230
Name:SOTO-MORALES, WILDALIZ
Entity type:Individual
Prefix:
First Name:WILDALIZ
Middle Name:
Last Name:SOTO-MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CALLE JOSE C BARBOSA
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 192238
Practice Address - Street 2:369 CALLE JOSE DE DIEGO LOCAL 103 TORRE MEDICA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-2238
Practice Address - Country:US
Practice Address - Phone:787-765-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist