Provider Demographics
NPI:1720790579
Name:SOSA, LETICIA IVONNE
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:IVONNE
Last Name:SOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 PALAZZO
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7577
Mailing Address - Country:US
Mailing Address - Phone:956-270-2225
Mailing Address - Fax:
Practice Address - Street 1:1703 PALAZZO
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7577
Practice Address - Country:US
Practice Address - Phone:956-270-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68388104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker