Individual
TIFFANY M SOTELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12255 FAIR LAKES PKWY, FAIRFAX, VA 22033-3952
(703) 934-4122
Mailing address
12255 FAIR LAKES PKWY, FAIRFAX, VA 22033-3952
(703) 934-4122
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101241947
VA
Other
Enumeration date
10/17/2006
Last updated
06/08/2021
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