Provider Demographics
NPI:1255761102
Name:SOTELO, LAURA (MHRS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SOTELO
Suffix:
Gender:F
Credentials:MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4168
Mailing Address - Country:US
Mailing Address - Phone:831-466-0924
Mailing Address - Fax:
Practice Address - Street 1:225 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4168
Practice Address - Country:US
Practice Address - Phone:831-466-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health