Provider Demographics
NPI:1518119098
Name:SOSA, GREGORIO (PA)
Entity Type:Individual
Prefix:
First Name:GREGORIO
Middle Name:
Last Name:SOSA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70180
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-0180
Mailing Address - Country:US
Mailing Address - Phone:951-523-0117
Mailing Address - Fax:951-475-7013
Practice Address - Street 1:9939 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3528
Practice Address - Country:US
Practice Address - Phone:855-505-7467
Practice Address - Fax:888-975-8926
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083641Medicaid
CAGR0083640Medicaid
CAZZZ19972ZMedicare PIN
CAGR0083640Medicaid