Provider Demographics
NPI:1164015160
Name:SOTELO, JESSE RUBALCADO JR (SUDRC)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:RUBALCADO
Last Name:SOTELO
Suffix:JR
Gender:M
Credentials:SUDRC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1124 BAKER ST OFC 206
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4322
Mailing Address - Country:US
Mailing Address - Phone:661-327-9376
Mailing Address - Fax:661-327-7649
Practice Address - Street 1:1124 BAKER ST OFC 206
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4322
Practice Address - Country:US
Practice Address - Phone:661-327-9376
Practice Address - Fax:661-329-7649
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11466101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)