Provider Demographics
NPI:1679099758
Name:FERNANDEZ SOSA, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FERNANDEZ 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 1:9601 SW 142ND AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6848
Mailing Address - Country:US
Mailing Address - Phone:832-516-5612
Mailing Address - Fax:
Practice Address - Street 1:9601 SW 142ND AVE APT 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6848
Practice Address - Country:US
Practice Address - Phone:832-516-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician