Healthcare Provider Details

I. General information

NPI: 1023352002
Provider Name (Legal Business Name): MS. VANESSA SOTELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 SILVER AVE
SAN FRANCISCO CA
94134-1229
US

IV. Provider business mailing address

1525 SILVER AVE
SAN FRANCISCO CA
94134-1229
US

V. Phone/Fax

Practice location:
  • Phone: 415-657-1704
  • Fax: 415-467-3320
Mailing address:
  • Phone: 415-657-1704
  • Fax: 415-467-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: