Provider Demographics
NPI:1255376679
Name:SOTOLONGO, RODOLFO P (MD)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:P
Last Name:SOTOLONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 7410
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7410
Mailing Address - Country:US
Mailing Address - Phone:409-835-5508
Mailing Address - Fax:409-835-3835
Practice Address - Street 1:2693 NORTH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1624
Practice Address - Country:US
Practice Address - Phone:409-832-8862
Practice Address - Fax:409-832-1664
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4209207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138475203Medicaid
TX138475202Medicaid
TX892701Medicare ID - Type Unspecified
TX89Z701Medicare PIN
TX138475202Medicaid
TX89Z690Medicare PIN
TX138475203Medicaid