Provider Demographics
NPI:1972386118
Name:SOTELO, RAPHAEL ADAN
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:ADAN
Last Name:SOTELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9005
Mailing Address - Country:US
Mailing Address - Phone:209-681-6084
Mailing Address - Fax:
Practice Address - Street 1:600 B ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-9593
Practice Address - Country:US
Practice Address - Phone:209-850-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH87813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist