=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205911203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAVIER SOSA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 08/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE. HOSTOS #410 SUITE 101
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-832-0653
-----------------------------------------------------
Fax | 787-832-0653
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 CALLE LUIS FELIPE DESSUS
-----------------------------------------------------
City | JUANA DIAZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00795-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-832-0653
-----------------------------------------------------
Fax | 787-831-0266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 14191
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------