Provider Demographics
NPI:1922497502
Name:SOTOMAYOR, EMILIO (MD SAC)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:
Last Name:SOTOMAYOR
Suffix:
Gender:M
Credentials:MD SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12981 SW 132ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7230
Mailing Address - Country:US
Mailing Address - Phone:786-333-7564
Mailing Address - Fax:
Practice Address - Street 1:1995 E OAKLAND PARK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1149
Practice Address - Country:US
Practice Address - Phone:954-791-6146
Practice Address - Fax:954-337-2733
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14-387246ZC0007X
FL14-387246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14-387Medicare PIN