Provider Demographics
NPI:1043817950
Name:SOTELO, IRMA BLASA (MC)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:BLASA
Last Name:SOTELO
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24321 114TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6961
Mailing Address - Country:US
Mailing Address - Phone:253-569-9535
Mailing Address - Fax:
Practice Address - Street 1:24321 114TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6961
Practice Address - Country:US
Practice Address - Phone:253-569-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7771171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty