Healthcare Provider Details

I. General information

NPI: 1679826945
Provider Name (Legal Business Name): SOTOLONGO CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S PEAR ORCHARD RD SUITE 7
RIDGELAND MS
39157-4800
US

IV. Provider business mailing address

731 S PEAR ORCHARD RD STE 7
RIDGELAND MS
39157-4839
US

V. Phone/Fax

Practice location:
  • Phone: 601-206-9101
  • Fax:
Mailing address:
  • Phone: 601-206-9101
  • Fax: 601-206-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSE M. SOTOLONGO
Title or Position: OWNER
Credential: DPM
Phone: 601-206-9101