Provider Demographics
NPI:1679826945
Name:SOTOLONGO CLINIC, PA
Entity Type:Organization
Organization Name:SOTOLONGO CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOTOLONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-206-9101
Mailing Address - Street 1:731 S PEAR ORCHARD RD STE 7
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4839
Mailing Address - Country:US
Mailing Address - Phone:601-206-9101
Mailing Address - Fax:601-206-9102
Practice Address - Street 1:731 S PEAR ORCHARD RD
Practice Address - Street 2:SUITE 7
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4800
Practice Address - Country:US
Practice Address - Phone:601-206-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOTOLONGO CLINIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-23
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty