Provider Demographics
NPI:1780637033
Name:SOSNA, MARILYN MAXINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:MAXINE
Last Name:SOSNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2472 CHAMBERS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6979
Mailing Address - Country:US
Mailing Address - Phone:714-505-1500
Mailing Address - Fax:714-505-1780
Practice Address - Street 1:2472 CHAMBERS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6979
Practice Address - Country:US
Practice Address - Phone:714-505-1500
Practice Address - Fax:714-505-1780
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA26143103TC0700X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26143OtherSTATE LICENSE
CAA26143OtherSTATE LICENSE