Healthcare Provider Details

I. General information

NPI: 1063338804
Provider Name (Legal Business Name): NICOLAS SOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 S BABCOCK ST
MELBOURNE FL
32901-6920
US

IV. Provider business mailing address

6920 ALTAMIRA ST
CORAL GABLES FL
33146-3814
US

V. Phone/Fax

Practice location:
  • Phone: 305-733-8869
  • Fax:
Mailing address:
  • Phone: 305-733-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: