MEDICARE: VALENTINA SASTOQUE SOTELO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710491089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALENTINA SASTOQUE SOTELO

Provider Business Mailing Address
First Line	:	8400 BUCK MOUNTAIN PASS
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3098
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 BUCK MOUNTAIN PASS
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3098
Country	:	US
Telephone Number	:	305-778-5357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2017
Last Update Date	:	07/01/2024

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