Provider Demographics
NPI:1982269908
Name:SOSA SEDA, MARIELA (DMD)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:SOSA SEDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND SKY TOWER II
Mailing Address - Street 2:1 CALLE HORTENSIA APT 8-I
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-467-1352
Mailing Address - Fax:
Practice Address - Street 1:CIDRA PROFESSIONAL EDIFICIO B LOCAL 3
Practice Address - Street 2:CARR 734 KM 0.5
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry