Healthcare Provider Details

I. General information

NPI: 1255408001
Provider Name (Legal Business Name): LUIS RAUL SOSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 W HERNDON AVE
FRESNO CA
93722-8401
US

IV. Provider business mailing address

4770 W HERNDON AVE
FRESNO CA
93722-8401
US

V. Phone/Fax

Practice location:
  • Phone: 559-271-6365
  • Fax: 559-271-6365
Mailing address:
  • Phone: 559-271-6365
  • Fax: 559-271-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA88028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: