Healthcare Provider Details

I. General information

NPI: 1386768026
Provider Name (Legal Business Name): RICARDO SOTOMORA M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 LILE DR STE 820
LITTLE ROCK AR
72205-6225
US

IV. Provider business mailing address

PO BOX 24607
LITTLE ROCK AR
72221-4607
US

V. Phone/Fax

Practice location:
  • Phone: 501-217-9890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICARDO SOTOMORA
Title or Position: PROVIDER
Credential: MD
Phone: 501-217-9890