MEDICARE: ROSSANNE M SOSA DDS

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	1223P0221X	Pediatric Dentistry	51418	CA

General Provider Information

NPI Number	:	1659571495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSSANNE M SOSA DDS

Provider Business Mailing Address
First Line	:	7830 CLAIREMONT MESA BLVD STE 208
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1632
Country	:	US
Telephone Number	:	858-496-9018
Fax Number	:	858-496-9034

Provider Business Practice Location Address
First Line	:	7830 CLAIREMONT MESA BLVD STE 208
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1632
Country	:	US
Telephone Number	:	858-496-9018
Fax Number	:	858-496-9034

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	05/08/2018

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