Provider Demographics
NPI:1720123656
Name:SOTO FONALLEDAS, SONIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:M
Last Name:SOTO FONALLEDAS
Suffix:
Gender:F
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:URB.PARKSIDE
Mailing Address - Street 2:CALLE 2 #B-18
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-296-4959
Mailing Address - Fax:877-895-0525
Practice Address - Street 1:URB. PARKSIDE
Practice Address - Street 2:CALLE 2 #B-18
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-296-4959
Practice Address - Fax:877-895-0525
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31924Medicare UPIN