Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 231 | NM |
NPI | 1295731628 |
---|---|
Provider Name | David R Sotelo |
First Address | Albuquerque, NM 87110-4608 |
Second Address | Albuquerque, NM 87110-4608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00053055 | (05) | NM |
U47179 | (02) | NM |