Healthcare Provider Details

I. General information

NPI: 1285503466
Provider Name (Legal Business Name): ANNA VICTORIA SOSA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE STE 2
MIAMI FL
33136-1087
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1087
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3000
  • Fax: 305-243-5274
Mailing address:
  • Phone: 305-243-3000
  • Fax: 305-243-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9121077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: