Healthcare Provider Details

I. General information

NPI: 1336649938
Provider Name (Legal Business Name): JOSE SANCHEZ SOSA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S 8TH ST STE B
DEMING NM
88030-4037
US

IV. Provider business mailing address

1420 S WHITTIER DR
DEMING NM
88030-5549
US

V. Phone/Fax

Practice location:
  • Phone: 575-543-7200
  • Fax: 575-544-4897
Mailing address:
  • Phone: 178-629-6454
  • Fax: 575-544-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9479995
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006080
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number60115
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: