Provider Demographics
NPI:1265160527
Name:GOMEZ SOTO, KAREN S I
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:GOMEZ SOTO
Suffix:I
Gender:F
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. BRISAS DEL MAR
Mailing Address - Street 2:CALLE SIRENA #O-37
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-535-8131
Mailing Address - Fax:
Practice Address - Street 1:CARR 3 KM 152.1
Practice Address - Street 2:BARRIADA LOPEZ
Practice Address - City:AGUIRRE
Practice Address - State:PR
Practice Address - Zip Code:00704
Practice Address - Country:US
Practice Address - Phone:787-535-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical