Provider Demographics
NPI:1306410287
Name:SOTELO SUAREZ, ISIS D (MD)
Entity type:Individual
Prefix:
First Name:ISIS
Middle Name:D
Last Name:SOTELO SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 SW 8TH ST STE 51
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2950
Mailing Address - Country:US
Mailing Address - Phone:786-312-2157
Mailing Address - Fax:
Practice Address - Street 1:9600 SW 8TH ST STE 51
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2950
Practice Address - Country:US
Practice Address - Phone:786-312-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1566208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice