Provider Demographics
NPI:1932232840
Name:SOSA, GLORIA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:MARIA
Last Name:SOSA
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:PO BOX 363648
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3648
Mailing Address - Country:US
Mailing Address - Phone:787-793-7929
Mailing Address - Fax:787-783-2975
Practice Address - Street 1:1110 AVE FD ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2907
Practice Address - Country:US
Practice Address - Phone:787-793-7929
Practice Address - Fax:787-783-2975
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10544208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82839Medicare ID - Type Unspecified