Healthcare Provider Details

I. General information

NPI: 1972347243
Provider Name (Legal Business Name): ISIS ILENA SOTELO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

12888 SW 60TH TER
MIAMI FL
33183-5408
US

V. Phone/Fax

Practice location:
  • Phone: 305-614-2901
  • Fax:
Mailing address:
  • Phone: 954-997-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11047821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: