Provider Demographics
NPI:1588986475
Name:SOTELO, REYNA J (NA)
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:J
Last Name:SOTELO
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-945-3350
Practice Address - Street 1:605 W OLYMPIC BLVD STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1475
Practice Address - Country:US
Practice Address - Phone:213-236-9388
Practice Address - Fax:213-489-7993
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes172V00000XOther Service ProvidersCommunity Health Worker