Provider Demographics
NPI:1851860548
Name:LOPEZ SOTOLONGO, EDGLIS (APRN)
Entity type:Individual
Prefix:
First Name:EDGLIS
Middle Name:
Last Name:LOPEZ SOTOLONGO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6822 W 2ND CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5302
Mailing Address - Country:US
Mailing Address - Phone:786-609-1910
Mailing Address - Fax:
Practice Address - Street 1:3448 NW 79TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4602
Practice Address - Country:US
Practice Address - Phone:855-226-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000084363LF0000X
FL1-24-74918103K00000X
FLAPRN11000084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily