Provider Demographics
NPI:1003304700
Name:SOSA, DOMINGO VICENTE
Entity Type:Individual
Prefix:
First Name:DOMINGO
Middle Name:VICENTE
Last Name:SOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1110
Mailing Address - Country:US
Mailing Address - Phone:347-556-4578
Mailing Address - Fax:
Practice Address - Street 1:8010 85TH AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1110
Practice Address - Country:US
Practice Address - Phone:347-556-4578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer