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General NPI Number Information
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NPI Number | 1629189139
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Entity Type | Individual
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Provider Name | JORGE F SOTOLONGO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 201 RIDGE ST #307
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-329-5700
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Fax | 712-329-5759
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Provider Business Mailing Address
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Address Line | 201 RIDGE ST #307
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4643
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Country | US
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Telephone | 712-329-5700
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Fax | 712-329-5759
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 18305
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 27364
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License Number State | IA
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