Provider Demographics
NPI:1265516660
Name:SOTOMAYOR, MELBA (MD)
Entity type:Individual
Prefix:DR
First Name:MELBA
Middle Name:
Last Name:SOTOMAYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELBA
Other - Middle Name:
Other - Last Name:SOTOMAYOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,
Mailing Address - Street 1:AGUADILLA MEDICAL PLAZA
Mailing Address - Street 2:AVENIDA SEVERIANO CUEVAS 24 SUITE 201
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-880-7380
Mailing Address - Fax:787-997-2090
Practice Address - Street 1:24 AVE SEVERIANO CUEVAS
Practice Address - Street 2:SUITE 201
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5762
Practice Address - Country:US
Practice Address - Phone:787-882-7380
Practice Address - Fax:787-997-2090
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7416174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28719OtherTRIPLE S
PR3637OtherPREFERRED MEDICARE CHOICE
PR601421OtherMEDICARE Y MUCHO MAS
PR8000075OtherHUMANA
PR3637OtherPREFERRED MEDICARE CHOICE
PR0028719Medicare ID - Type Unspecified