Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16616 | PR |
NPI | 1013005974 |
---|---|
Provider Name | Carlos A Sosa |
First Address | San Juan, PR 00936 |
Second Address | Guaynabo, PR 00966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |