Provider Demographics
NPI:1417258450
Name:SOSA, SALLY ANN
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
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 1:5005 4TH ST NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3916
Mailing Address - Country:US
Mailing Address - Phone:505-212-7340
Mailing Address - Fax:505-271-2870
Practice Address - Street 1:5005 4TH ST NW
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3916
Practice Address - Country:US
Practice Address - Phone:505-212-7340
Practice Address - Fax:505-271-2870
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator