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General NPI Number Information
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NPI Number | 1306113154
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Entity Type | Individual
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Provider Name | EILEEN J SANTA-SOSA PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 1935 MEDICAL DISTRICT DR MAIL DROP F3.37 ROOM# F334, ATTN: EILEEN SANTA-SOSA PHD
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City | DALLAS
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State | TX
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Zip | 75235-7701
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Country | US
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Telephone | 214-456-6923
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Fax |
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Provider Business Mailing Address
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Address Line | 1935 MEDICAL DISTRICT DR MAIL DROP F3.37 ROOM# F334, ATTN: EILEEN SANTA-SOSA PHD
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City | DALLAS
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State | TX
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Zip | 75235-7701
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Country | US
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Telephone | 214-456-6923
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 04951
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License Number State | MD
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