MEDICARE: MRS. SARA MARGARIDA SOUSA NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AC000682	MD
2	363LF0000X	Family Nurse Practitioner	17053	CA

General Provider Information

NPI Number	:	1629251269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA MARGARIDA SOUSA NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 64131
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4131
Country	:	US
Telephone Number	:	443-481-6480
Fax Number	:	443-481-6515

Provider Business Practice Location Address
First Line	:	855 3RD AVE STE 4400
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-1350
Country	:	US
Telephone Number	:	619-240-8242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/14/2022

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