Provider Demographics
NPI:1750892824
Name:SOSA, DAGMA
Entity type:Individual
Prefix:MRS
First Name:DAGMA
Middle Name:
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 1:21551 SW 113TH AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2731
Mailing Address - Country:US
Mailing Address - Phone:786-970-2879
Mailing Address - Fax:
Practice Address - Street 1:21551 SW 113TH AVE APT 108
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2731
Practice Address - Country:US
Practice Address - Phone:786-970-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty