Provider Demographics
NPI:1194863670
Name:SOZA, PATRICIA L (LAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:SOZA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 SOQUEL DR STE D
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3184
Mailing Address - Country:US
Mailing Address - Phone:831-227-7859
Mailing Address - Fax:
Practice Address - Street 1:6233 SOQUEL DR STE D
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3184
Practice Address - Country:US
Practice Address - Phone:831-227-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9844171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0098440Medicaid