Provider Demographics
NPI:1669861894
Name:SOSA, GILDA
Entity Type:Individual
Prefix:
First Name:GILDA
Middle Name:
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 1:2300 W 84TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5771
Mailing Address - Country:US
Mailing Address - Phone:786-666-0507
Mailing Address - Fax:786-666-0419
Practice Address - Street 1:2300 W 84TH ST STE 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5771
Practice Address - Country:US
Practice Address - Phone:786-666-0507
Practice Address - Fax:786-666-0419
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1669861894Medicaid