Provider Demographics
NPI:1770906448
Name:SOTO, NAHIR (OD)
Entity type:Individual
Prefix:DR
First Name:NAHIR
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CALLE REGENCIA
Mailing Address - Street 2:PASEO REAL
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9814
Mailing Address - Country:US
Mailing Address - Phone:787-406-3562
Mailing Address - Fax:939-697-6104
Practice Address - Street 1:16 CALLE RAFAEL OCASIO
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3240
Practice Address - Country:US
Practice Address - Phone:787-824-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR715152W00000X
PR828156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7340070001Medicare PIN