Healthcare Provider Details

I. General information

NPI: 1770245904
Provider Name (Legal Business Name): LILIMAE SOTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD STE 211
GARDEN GROVE CA
92843-1916
US

IV. Provider business mailing address

1714 KINGSTON RD
PLACENTIA CA
92870-2524
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-2890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: