Provider Demographics
NPI:1306410287
Name:SOTELO, ISIS DE LA CANDELARIA (MD)
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:DE LA CANDELARIA
Last Name:SOTELO
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 1:1031 NW 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2343
Mailing Address - Country:US
Mailing Address - Phone:786-312-2157
Mailing Address - Fax:
Practice Address - Street 1:167 W 23RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2211
Practice Address - Country:US
Practice Address - Phone:305-889-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1566208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice