Provider Demographics
NPI:1487902110
Name:SOTERO, ANGEL S (PSYCHOLOGIST)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:S
Last Name:SOTERO
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE MARLIN D-19 BAHIA VISTAMAR
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-0000
Mailing Address - Country:US
Mailing Address - Phone:787-644-2290
Mailing Address - Fax:787-757-7762
Practice Address - Street 1:BAHIA VISTAMAR
Practice Address - Street 2:D-19 CALLE MARLIN
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-1408
Practice Address - Country:US
Practice Address - Phone:787-644-2290
Practice Address - Fax:787-757-7762
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2607103T00000X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)