Provider Demographics
NPI:1609451681
Name:SOSA, NANCY GARCIA
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:GARCIA
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 1:9064 CAMINO LAGO VIS
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6427
Mailing Address - Country:US
Mailing Address - Phone:619-832-3431
Mailing Address - Fax:
Practice Address - Street 1:2464 FENTON PKWY APT 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6705
Practice Address - Country:US
Practice Address - Phone:619-787-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD5818173OtherDRIVER LICENSE