Provider Demographics
NPI:1093176075
Name:SOTOLONGO, PATRICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:SOTOLONGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:SOTOLONGO-DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:49838 CRESCENT PSGE
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2212
Mailing Address - Country:US
Mailing Address - Phone:760-992-7171
Mailing Address - Fax:
Practice Address - Street 1:1100 N INDIAN CYN DR STE 109
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4418
Practice Address - Country:US
Practice Address - Phone:760-992-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A16279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program