Healthcare Provider Details

I. General information

NPI: 1699938472
Provider Name (Legal Business Name): EDGAR SOSA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 HIGHWAY A1A STE A
VERO BEACH FL
32963-1229
US

IV. Provider business mailing address

5070 HIGHWAY A1A STE A
VERO BEACH FL
32963-1229
US

V. Phone/Fax

Practice location:
  • Phone: 772-234-3700
  • Fax: 772-234-3770
Mailing address:
  • Phone: 772-234-3700
  • Fax: 772-234-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberOS-14580
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberOS-14580
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: