Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 009828 | GA |
Y | 111NN0400X | Neurology | 0631 | PR |
NPI | 1760922082 |
---|---|
Provider Name | Vilmarie Soto Gonzalez |
First Address | San Juan, PR 00926 |
Second Address | Carolina, PR 00987-4701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 06/03/2017 |