Provider Demographics
NPI:1396240511
Name:SOTOMAYOR VILLANUEVA, FIORELLA SONIA (MD)
Entity type:Individual
Prefix:
First Name:FIORELLA
Middle Name:SONIA
Last Name:SOTOMAYOR VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4506
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71134-0506
Mailing Address - Country:US
Mailing Address - Phone:318-239-4860
Mailing Address - Fax:805-295-4715
Practice Address - Street 1:3516 NORTH BLVD STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3674
Practice Address - Country:US
Practice Address - Phone:318-239-4860
Practice Address - Fax:805-295-4715
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA337976207RE0101X
LA000000207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism