Provider Demographics
NPI:1205980661
Name:SOSA, WILFREDO (HSCS)
Entity type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:
Last Name:SOSA
Suffix:
Gender:M
Credentials:HSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 SAN JOSE DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6506
Mailing Address - Country:US
Mailing Address - Phone:415-382-6085
Mailing Address - Fax:
Practice Address - Street 1:COMDT CG-1122, U. S. COAST GUARD
Practice Address - Street 2:2100 2ND ST SW, SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20953
Practice Address - Country:US
Practice Address - Phone:510-637-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other