Provider Demographics
NPI:1225624943
Name:SASOSA PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SASOSA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL TORO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:832-617-6300
Mailing Address - Street 1:6776 SOUTHWEST FWY STE 530
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2111
Mailing Address - Country:US
Mailing Address - Phone:832-617-6300
Mailing Address - Fax:832-767-1823
Practice Address - Street 1:6776 SOUTHWEST FWY STE 530
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2111
Practice Address - Country:US
Practice Address - Phone:832-617-6300
Practice Address - Fax:832-767-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty