Healthcare Provider Details

I. General information

NPI: 1437551934
Provider Name (Legal Business Name): PAULA KATHLEEN SOSA CADCIII, B0000790420
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA KATHLEEN CARLISLE-RODRIQUEZ CADCIII, B0000790420

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LAS PLUMAS AVE STE K
SAN JOSE CA
95133-1657
US

IV. Provider business mailing address

1650 LAS PLUMAS AVE STE K
SAN JOSE CA
95133-1657
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-6726
  • Fax: 408-259-0865
Mailing address:
  • Phone: 408-272-6726
  • Fax: 408-259-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADCIII-B0000790420
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberCADCIII-B0000790420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: