Provider Demographics
NPI:1912701525
Name:SOTELO, CELIA
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:SOTELO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3591 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2654
Mailing Address - Country:US
Mailing Address - Phone:310-223-1035
Mailing Address - Fax:310-638-9080
Practice Address - Street 1:3591 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2654
Practice Address - Country:US
Practice Address - Phone:310-223-1035
Practice Address - Fax:310-638-9080
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker