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General NPI Number Information
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NPI Number | 1174006886
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Entity Type | Individual
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Provider Name | ANDREA SOSA
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Gender | Female
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Dates
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Enumeration Date | 09/09/2018
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Last Update Date | 09/09/2018
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Provider Practice Location Address
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Address Line | 81 PROFESSIONAL CENTER PKWY
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2702
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Country | US
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Telephone | 415-479-5161
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 KEARNY ST
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City | PETALUMA
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State | CA
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Zip | 94954-3614
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Country | US
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Telephone | 415-264-7672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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