Provider Demographics
NPI:1235223264
Name:SOTELO, SERGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:SOTELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8573 E SAN ALBERTO DR
Mailing Address - Street 2:SUITE E-100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4318
Mailing Address - Country:US
Mailing Address - Phone:480-778-1732
Mailing Address - Fax:480-778-1709
Practice Address - Street 1:8573 E SAN ALBERTO DR
Practice Address - Street 2:SUITE E-100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4318
Practice Address - Country:US
Practice Address - Phone:480-778-1732
Practice Address - Fax:480-778-1709
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ151543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z2246OtherHEALTHNET
AZ255275OtherAHCCCS
AZAZ0187160OtherBCBS
AZ4223526OtherAENTA