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General NPI Number Information
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NPI Number | 1205337763
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Entity Type | Organization
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Legal Business Name | JOSE M. SOSA, DDS, INC.
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 1235 W VISTA WAY STE L
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City | VISTA
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State | CA
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Zip | 92083-6234
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Country | US
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Telephone | 760-730-0168
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Fax | 760-730-0189
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Provider Business Mailing Address
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Address Line | 1235 W VISTA WAY STE L
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City | VISTA
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State | CA
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Zip | 92083-6234
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Country | US
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Telephone | 760-730-0168
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Fax | 760-730-0189
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Authorized Official
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Title or Position | CEO
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Name | DR. JOSE M SOSA
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Credential | DDS
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Telephone | 760-730-0168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 56379
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License Number State | CA
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