Active NPI
Jonathan Madera Soto, PSY.D
- Psychologist
- San Sebastian, PR
National Provider Identifier
1720701568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6661
- Practice address
- Bo. Cibao Sector Finca Los Robles
Carr. 119 Ramal 455 K 10.2
San Sebastian, PR 00685 - Phone
- (787) 436-1394
- NPI assigned
- Sep 26, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6661 | PR | Primary |
Addresses
Primary practice location
Bo. Cibao Sector Finca Los Robles
Carr. 119 Ramal 455 K 10.2
San Sebastian, PR 00685
Mailing address
HC 4 Box 44285
Lares, PR 00669-9592
Phone (787) 436-1394
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6661 | PR | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1720701568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 4 BOX 44285",
"city": "LARES",
"state": "PR",
"postal_code": "006699592",
"telephone_number": "787-436-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BO. CIBAO SECTOR FINCA LOS ROBLES",
"address_2": "CARR. 119 RAMAL 455 K 10.2",
"city": "SAN SEBASTIAN",
"state": "PR",
"postal_code": "00685",
"telephone_number": "787-436-1394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADERA SOTO",
"first_name": "JONATHAN",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-26",
"last_updated": "2022-09-26",
"certification_date": "2022-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PR",
"license": "6661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Sebastian, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.