Healthcare Provider Details

I. General information

NPI: 1700063443
Provider Name (Legal Business Name): WENDY GENTILE SOSA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 S. OCEAN DRIVE 1209
HOLLYWOOD FL
33019
US

IV. Provider business mailing address

3505 S OCEAN DR 1209
HOLLYWOOD FL
33019-2831
US

V. Phone/Fax

Practice location:
  • Phone: 954-257-3663
  • Fax:
Mailing address:
  • Phone: 954-257-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number38843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: