Healthcare Provider Details

I. General information

NPI: 1043761109
Provider Name (Legal Business Name): BRISSA SOTELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 05/11/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8519 MESA SPRINGS AVE SW
ALBUQUERQUE NM
87121-7037
US

IV. Provider business mailing address

8519 MESA SPRINGS AVE SW
ALBUQUERQUE NM
87121-7037
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-7750
  • Fax:
Mailing address:
  • Phone: 505-239-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: