Provider Demographics
NPI:1982267019
Name:SOSA, MARIELA DELCARMEN
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:DELCARMEN
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 1:1112 LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4802
Mailing Address - Country:US
Mailing Address - Phone:646-842-1972
Mailing Address - Fax:
Practice Address - Street 1:1112 LELAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4802
Practice Address - Country:US
Practice Address - Phone:646-842-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty