Provider Demographics
NPI:1750100483
Name:MENDOZA SOTO, CRISTINA ALEJANDRA
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ALEJANDRA
Last Name:MENDOZA SOTO
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:HC 58 BOX 13460
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9891
Mailing Address - Country:US
Mailing Address - Phone:787-464-0138
Mailing Address - Fax:
Practice Address - Street 1:HC 58 BOX 13460
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9891
Practice Address - Country:US
Practice Address - Phone:787-464-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
PR16342183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician