Provider Demographics
NPI:1689998247
Name:ROBERTO SOTOLONGO MD PA
Entity Type:Organization
Organization Name:ROBERTO SOTOLONGO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTOLONGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-421-3758
Mailing Address - Street 1:11760 SW 156TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6896
Mailing Address - Country:US
Mailing Address - Phone:787-421-3758
Mailing Address - Fax:786-787-7359
Practice Address - Street 1:11760 SW 156TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6896
Practice Address - Country:US
Practice Address - Phone:787-421-3758
Practice Address - Fax:786-787-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000627400Medicaid