Provider Demographics
NPI:1184923591
Name:SOSA, JIMI
Entity type:Individual
Prefix:MR
First Name:JIMI
Middle Name:
Last Name:SOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ALAMEDA DE LAS PULGAS STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1271
Mailing Address - Country:US
Mailing Address - Phone:650-372-8513
Mailing Address - Fax:560-522-9830
Practice Address - Street 1:2000 ALAMEDA DE LAS PULGAS STE 240
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1271
Practice Address - Country:US
Practice Address - Phone:650-372-8513
Practice Address - Fax:560-522-9830
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health