Provider Demographics
NPI:1932396801
Name:SOTELO, JOSE FAVOR (RN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FAVOR
Last Name:SOTELO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7337 N LINCOLN AVE
Mailing Address - Street 2:SUITE 295
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1700
Mailing Address - Country:US
Mailing Address - Phone:847-673-4110
Mailing Address - Fax:847-673-0478
Practice Address - Street 1:7337 N LINCOLN AVE
Practice Address - Street 2:SUITE 295
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1700
Practice Address - Country:US
Practice Address - Phone:847-673-4110
Practice Address - Fax:847-673-0478
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator