Provider Demographics
NPI:1124472162
Name:SOZA, GABRIELA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:MARIE
Last Name:SOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 22ND ST APT N803
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5470
Mailing Address - Country:US
Mailing Address - Phone:361-960-2663
Mailing Address - Fax:
Practice Address - Street 1:911 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0385
Practice Address - Country:US
Practice Address - Phone:212-772-7242
Practice Address - Fax:212-517-9566
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2514207N00000X, 207NS0135X
NY305575207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology