MEDICARE: CAMILO SUAREZ SOTOMAYOR

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	101YM0800X	Mental Health Counselor		NV

General Provider Information

NPI Number	:	1972214278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILO SUAREZ SOTOMAYOR

Provider Business Mailing Address
First Line	:	4405 LA REINA CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-5101
Country	:	US
Telephone Number	:	702-931-0735
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 LA REINA CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-5101
Country	:	US
Telephone Number	:	702-931-0735
Fax Number	:

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

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	12/07/2022

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Directions to “ CAMILO SUAREZ SOTOMAYOR ” Practice Location

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