Healthcare Provider Details

I. General information

NPI: 1346076155
Provider Name (Legal Business Name): CORDELIA LIEBERMAN SOTELO MEDICAL DOCTOR MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 N BELLFLOWER BLVD STE 210
LONG BEACH CA
90815-4020
US

IV. Provider business mailing address

220 BENNETT AVE
LONG BEACH CA
90803-1526
US

V. Phone/Fax

Practice location:
  • Phone: 562-248-2999
  • Fax: 562-248-2998
Mailing address:
  • Phone: 323-270-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CORDELIA LIEBERMAN SOTELO
Title or Position: CEO
Credential: MD
Phone: 562-248-2999