Healthcare Provider Details

I. General information

NPI: 1316589799
Provider Name (Legal Business Name): DANIEL MARC SOSIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 S SAINT FRANCIS DR # N-1053
SANTA FE NM
87505-4173
US

IV. Provider business mailing address

1454 MIRACERROS LOOP S
SANTA FE NM
87505-4024
US

V. Phone/Fax

Practice location:
  • Phone: 505-827-2271
  • Fax: 505-827-0013
Mailing address:
  • Phone: 678-570-8574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2019-0456
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD2019-0456
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: