Provider Demographics
NPI:1518492404
Name:SOSA HERNANDEZ, ROBERTO (SA-C)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:SOSA HERNANDEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SW 27TH AVE
Mailing Address - Street 2:APT 21
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2970
Mailing Address - Country:US
Mailing Address - Phone:786-803-2657
Mailing Address - Fax:
Practice Address - Street 1:444 SW 27TH AVE
Practice Address - Street 2:APT 21
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2970
Practice Address - Country:US
Practice Address - Phone:786-803-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14-152246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant