MEDICARE: MRS. ELIZABETH ANN SOTELO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224900000X	Mastectomy Fitter	C54120	CA

General Provider Information

NPI Number	:	1275251399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN SOTELO

Provider Business Mailing Address
First Line	:	1400 CALLOWAY DR STE 202
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-2842
Country	:	US
Telephone Number	:	661-835-8120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 CALLOWAY DR STE 202
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-2842
Country	:	US
Telephone Number	:	661-835-8120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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