Provider Demographics
NPI:1255471397
Name:SOTELO, ANNE GRACE (CAMTC#27980)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:GRACE
Last Name:SOTELO
Suffix:
Gender:F
Credentials:CAMTC#27980
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11936 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5810
Mailing Address - Country:US
Mailing Address - Phone:310-396-3566
Mailing Address - Fax:310-230-5175
Practice Address - Street 1:11936 LOUISE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5810
Practice Address - Country:US
Practice Address - Phone:310-396-3566
Practice Address - Fax:310-230-5175
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27980OtherCALIFORNIA MASSAGE THERAPY COUNCIL