Provider Demographics
NPI:1669551479
Name:PEREZ-SOTO, BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PEREZ-SOTO
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:BASORA 55N OFF 209 MEDICO IV
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00080
Mailing Address - Country:US
Mailing Address - Phone:787-832-7378
Mailing Address - Fax:787-805-5440
Practice Address - Street 1:BASORA 55N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00080
Practice Address - Country:US
Practice Address - Phone:787-832-7378
Practice Address - Fax:787-805-5440
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5355208800000X
CAA36841208800000X
FLME50601208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0097921Medicare ID - Type Unspecified
C78209Medicare UPIN