Provider Demographics
NPI:1427039775
Name:SOSA, GODYS (ND)
Entity Type:Individual
Prefix:
First Name:GODYS
Middle Name:
Last Name:SOSA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5147
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9745
Mailing Address - Country:US
Mailing Address - Phone:787-799-4116
Mailing Address - Fax:787-730-1403
Practice Address - Street 1:330 AVE LOS DOMINICOS # URB
Practice Address - Street 2:AVE LOS DOMINICOS BLOQUE # 8
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-6707
Practice Address - Country:US
Practice Address - Phone:787-799-4116
Practice Address - Fax:787-730-1403
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTRIPLE SOtherTRIPLES