Provider Demographics
NPI:1235271313
Name:SOSA, MARILUZ
Entity Type:Individual
Prefix:
First Name:MARILUZ
Middle Name:
Last Name:SOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB COLINAS VERDES
Mailing Address - Street 2:CALLE 1 R-20
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-381-5566
Mailing Address - Fax:787-896-3090
Practice Address - Street 1:1001 AVE EMERITO ESTRADA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3008
Practice Address - Country:US
Practice Address - Phone:787-896-3090
Practice Address - Fax:787-896-3090
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1065183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician