Provider Demographics
NPI:1295447845
Name:SOZANGO INC
Entity type:Organization
Organization Name:SOZANGO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-507-0717
Mailing Address - Street 1:32565 GOLDEN LANTERN ST STE B270
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3247
Mailing Address - Country:US
Mailing Address - Phone:866-507-0717
Mailing Address - Fax:
Practice Address - Street 1:32565 GOLDEN LANTERN ST STE B270
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3247
Practice Address - Country:US
Practice Address - Phone:866-507-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty