Provider Demographics
NPI:1831410901
Name:SOTA, JESSIKA (LMT)
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:
Last Name:SOTA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:
Other - Last Name:SAVAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:150 W HUFFAKER LN STE 105
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 W HUFFAKER LN STE 105
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2098
Practice Address - Country:US
Practice Address - Phone:775-830-6524
Practice Address - Fax:775-852-4342
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV107246174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist