Healthcare Provider Details

I. General information

NPI: 1831817584
Provider Name (Legal Business Name): JORGE SOTELO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 W PIERCE ST
CARLSBAD NM
88220-3514
US

IV. Provider business mailing address

PO BOX 3141
CARLSBAD NM
88221-3141
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5552
  • Fax: 575-725-5552
Mailing address:
  • Phone: 575-725-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0310
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: