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General NPI Number Information
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NPI Number | 1598498313
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Entity Type | Individual
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Provider Name | ALEXIS RAUL GARCIA SOSA
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Gender | Male
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 02/18/2023
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Provider Practice Location Address
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Address Line | 3720 SW 107TH AVE STE 1
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City | MIAMI
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State | FL
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Zip | 33165-3639
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Country | US
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Telephone | 305-775-6505
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Fax | 305-553-5271
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Provider Business Mailing Address
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Address Line | 4500 SW 116TH AVE
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City | MIAMI
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State | FL
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Zip | 33165-5536
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11020356
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License Number State | FL
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