Healthcare Provider Details

I. General information

NPI: 1487145116
Provider Name (Legal Business Name): ALEX MURILLO-SOTELO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 COALINGA PLZ
COALINGA CA
93210-1704
US

IV. Provider business mailing address

380 COALINGA PLZ
COALINGA CA
93210-1704
US

V. Phone/Fax

Practice location:
  • Phone: 855-343-1057
  • Fax: 844-587-6405
Mailing address:
  • Phone: 855-343-1057
  • Fax: 844-587-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number90352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: