Provider Demographics
NPI:1174853261
Name:SOTOCA, FERNANDO
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:SOTOCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA UNIVERSITARIA CALLE 35
Mailing Address - Street 2:BG 11
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-349-7276
Mailing Address - Fax:
Practice Address - Street 1:STREET 35 VILLA UNIVERSITARIA
Practice Address - Street 2:BG 11
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4365
Practice Address - Country:US
Practice Address - Phone:787-349-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11442355S0801X
PR1701225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant