Provider Demographics
NPI:1184755597
Name:SOTO, BLANCA CRUZ (PSYD)
Entity type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:CRUZ
Last Name:SOTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB ESTANCIASDE TORTUGUERO
Mailing Address - Street 2:CALLE TOLEDO #123
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-858-4333
Mailing Address - Fax:787-858-4333
Practice Address - Street 1:URB VILLA REAL CALLE 1 A 2
Practice Address - Street 2:VILLE REAL BLDG SUITE #5
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-4333
Practice Address - Fax:787-858-4333
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056721Medicare ID - Type Unspecified
OTH000Medicare UPIN