Healthcare Provider Details

I. General information

NPI: 1659263465
Provider Name (Legal Business Name): MARIANNY SOTELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N TELSHOR BLVD STE E
LAS CRUCES NM
88011-8279
US

IV. Provider business mailing address

2236 SANTA ANA
LAS CRUCES NM
88011-9082
US

V. Phone/Fax

Practice location:
  • Phone: 575-621-0217
  • Fax:
Mailing address:
  • Phone: 575-636-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0839
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2025-0462
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: