Provider Demographics
NPI:1851953400
Name:SOSA, CHRISTOPHER MAURICIO
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MAURICIO
Last Name:SOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11024 BALBOA BLVD # 295
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5007
Mailing Address - Country:US
Mailing Address - Phone:818-366-0360
Mailing Address - Fax:
Practice Address - Street 1:16912 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4249
Practice Address - Country:US
Practice Address - Phone:818-488-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical