Provider Demographics
NPI:1376176263
Name:PAULO, CORAZON SOTELO (RN)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:SOTELO
Last Name:PAULO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CORAZON
Other - Middle Name:SOTELO
Other - Last Name:BALTAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 E WILBARGER ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-5915
Mailing Address - Country:US
Mailing Address - Phone:682-412-7916
Mailing Address - Fax:
Practice Address - Street 1:318 E WILBARGER ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-5915
Practice Address - Country:US
Practice Address - Phone:682-412-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX855570163WG0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice