Provider Demographics
NPI:1770102782
Name:SOTELO, MIGUEL IGNACIO SAMANO (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:IGNACIO SAMANO
Last Name:SOTELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1020 TIETON ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:TIETON
Mailing Address - State:WA
Mailing Address - Zip Code:98947-9734
Mailing Address - Country:US
Mailing Address - Phone:509-985-8378
Mailing Address - Fax:
Practice Address - Street 1:14406 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1448
Practice Address - Country:US
Practice Address - Phone:503-813-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD216222207Q00000X
WAMD.MD.61435275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine