Provider Demographics
NPI:1770568586
Name:SOTOMAYOR-SIERRA, ANTONIO E (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:E
Last Name:SOTOMAYOR-SIERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3497
Mailing Address - Country:US
Mailing Address - Phone:787-799-5018
Mailing Address - Fax:787-279-4941
Practice Address - Street 1:LAS CUMBRES AVE.
Practice Address - Street 2:AB-5, REXVILLE NO.2
Practice Address - City:BAYAMON,
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-799-5018
Practice Address - Fax:787-279-4941
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7099207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-8767Medicare ID - Type Unspecified
PRC-79780Medicare UPIN