Provider Demographics
NPI:1669134003
Name:SOTOMAYOR-ADRIAN, IVETTE ROSARIO
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:ROSARIO
Last Name:SOTOMAYOR-ADRIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15380 SW 19TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5725
Mailing Address - Country:US
Mailing Address - Phone:305-213-5529
Mailing Address - Fax:
Practice Address - Street 1:221 SW 124TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1415
Practice Address - Country:US
Practice Address - Phone:305-213-5529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist