Healthcare Provider Details

I. General information

NPI: 1275009912
Provider Name (Legal Business Name): ALEXIS SOTIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19646 N 27TH AVE STE 305
PHOENIX AZ
85027-4027
US

IV. Provider business mailing address

19646 N 27TH AVE STE 305
PHOENIX AZ
85027-4027
US

V. Phone/Fax

Practice location:
  • Phone: 480-556-0446
  • Fax:
Mailing address:
  • Phone: 480-556-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7598
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: