Provider Demographics
NPI:1760478846
Name:SOTOLONGO, IGNACIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:A
Last Name:SOTOLONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12868
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-2868
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:620 10TH STREET N.
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-8274
Practice Address - Fax:727-824-8293
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63236207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375013200Medicaid
25096WMedicare PIN
FL375013200Medicaid