Basic Information
| Provider Information | |||||||||
| NPI: | 1255376679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOTOLONGO | ||||||||
| FirstName: | RODOLFO | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 7410 | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777267410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098355508 | ||||||||
| FaxNumber: | 4098353835 | ||||||||
| Practice Location | |||||||||
| Address1: | 2693 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098328862 | ||||||||
| FaxNumber: | 4098321664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 05/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | G4209 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 138475203 | 05 | TX | MEDICAID | 138475202 | 05 | TX | MEDICAID |