Provider Demographics
NPI:1801320247
Name:SOTO MARTINEZ, GUILLERMO ELIEZER (MD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ELIEZER
Last Name:SOTO MARTINEZ
Suffix:
Gender:M
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:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:LAS MARIAS
Mailing Address - State:PR
Mailing Address - Zip Code:00670-0371
Mailing Address - Country:US
Mailing Address - Phone:787-827-8177
Mailing Address - Fax:787-827-8178
Practice Address - Street 1:CARRETERA 120 KM 0.1
Practice Address - Street 2:
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670-0371
Practice Address - Country:US
Practice Address - Phone:787-827-8177
Practice Address - Fax:787-827-8178
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19599208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice