Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D13124 | MN |
NPI | 1013275049 |
---|---|
Provider Name | Julio Sotillo Rodriguez |
First Address | Minneapolis, MN 55455-0357 |
Second Address | Minneapolis, MN 55454-1513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2012 |
Last Update Date | 10/08/2015 |