Provider Demographics
NPI:1598049769
Name:SOSA, DIANARYS (MS, PHL)
Entity Type:Individual
Prefix:
First Name:DIANARYS
Middle Name:
Last Name:SOSA
Suffix:
Gender:F
Credentials:MS, PHL
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 9084
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9084
Mailing Address - Country:US
Mailing Address - Phone:787-637-8407
Mailing Address - Fax:
Practice Address - Street 1:27-16 AVE ROBERTO CLEMENTE
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5420
Practice Address - Country:US
Practice Address - Phone:787-637-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR645174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist