Provider Demographics
NPI:1033276878
Name:SOTOMAYOR, ADORACION POBLETE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADORACION
Middle Name:POBLETE
Last Name:SOTOMAYOR
Suffix:
Gender:F
Credentials:MD
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 608
Mailing Address - Street 2:365 WEST OLIVER STREET
Mailing Address - City:BALDWIN
Mailing Address - State:FL
Mailing Address - Zip Code:32234-0608
Mailing Address - Country:US
Mailing Address - Phone:904-266-9223
Mailing Address - Fax:
Practice Address - Street 1:365 WEST OLIVER STREET
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:FL
Practice Address - Zip Code:32234-0608
Practice Address - Country:US
Practice Address - Phone:904-266-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D67126Medicare UPIN
15378Medicare ID - Type Unspecified