Provider Demographics
NPI:1750892295
Name:KIMBERLY M SOTO MIELES
Entity type:Organization
Organization Name:KIMBERLY M SOTO MIELES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MT.
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOTO MIELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-669-5407
Mailing Address - Street 1:PO BOX 2911
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-6911
Mailing Address - Country:US
Mailing Address - Phone:787-669-5407
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 111 KM 27.6 BARRIO JUNCAL
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-6911
Practice Address - Country:US
Practice Address - Phone:787-669-5407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1366291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory