Provider Demographics
NPI:1619984036
Name:URBISTONDO SOTO, VICENTE JUAN (AUD)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:JUAN
Last Name:URBISTONDO SOTO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270454
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-2454
Mailing Address - Country:US
Mailing Address - Phone:787-641-7582
Mailing Address - Fax:787-641-0654
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:ASPS(126)
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-641-0654
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR266231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR60244Medicare ID - Type Unspecified