Provider Demographics
NPI:1134464555
Name:SOTELO, CRISTINA
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:SOTELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9708 SYDNEY MARILYN LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3086
Mailing Address - Country:US
Mailing Address - Phone:702-580-8311
Mailing Address - Fax:
Practice Address - Street 1:9708 SYDNEY MARILYN LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3086
Practice Address - Country:US
Practice Address - Phone:702-580-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45344183500000X
NV12452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist