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General NPI Number Information
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NPI Number | 1225287576
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Entity Type | Individual
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Provider Name | IVETTE M. SOSA SEDA M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 15255 MAX LEGGET PKWY STE 5100
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City | JACKSONVILLE
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State | FL
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Zip | 32218-7274
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Country | US
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Telephone | 904-541-0315
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Fax | 904-541-0316
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Provider Business Mailing Address
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Address Line | 906 PARK AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4120
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Country | US
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Telephone | 904-541-0315
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Fax | 904-541-0316
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME133840
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License Number State | FL
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