Provider Demographics
NPI:1548617939
Name:SOLTERO, ITZEL ELENA (LMSW)
Entity type:Individual
Prefix:
First Name:ITZEL
Middle Name:ELENA
Last Name:SOLTERO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 N ROADRUNNER PKWY
Mailing Address - Street 2:3906
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8112
Mailing Address - Country:US
Mailing Address - Phone:575-652-1815
Mailing Address - Fax:
Practice Address - Street 1:2775 N ROADRUNNER PKWY
Practice Address - Street 2:3906
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8112
Practice Address - Country:US
Practice Address - Phone:575-652-1815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-09506104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker