Provider Demographics
NPI:1538483037
Name:SOTELO, SUNARA H (EAMP, DAOM)
Entity type:Individual
Prefix:
First Name:SUNARA
Middle Name:H
Last Name:SOTELO
Suffix:
Gender:F
Credentials:EAMP, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 HONEYSUCKLE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1168
Mailing Address - Country:US
Mailing Address - Phone:334-792-5868
Mailing Address - Fax:
Practice Address - Street 1:256 HONEYSUCKLE RD STE 4
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1168
Practice Address - Country:US
Practice Address - Phone:334-792-5868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60127491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC60127491OtherACUPUNCTURE LICENSE