Healthcare Provider Details

I. General information

NPI: 1902866189
Provider Name (Legal Business Name): SOSAN L. MOUSSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 N ALVERNON WAY
TUCSON AZ
85712-3321
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100
TUCSON AZ
85711-3629
US

V. Phone/Fax

Practice location:
  • Phone: 520-325-8000
  • Fax: 520-325-8616
Mailing address:
  • Phone: 520-382-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number27593
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27593
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: