MEDICARE: CARLOS ALBERTO SOSA ROSALES

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	251B00000X	Case Management Agency	CCM100159-A	FL

General Provider Information

NPI Number	:	1922503820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS ALBERTO SOSA ROSALES

Provider Business Mailing Address
First Line	:	11042 SW 241ST ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-5138
Country	:	US
Telephone Number	:	786-356-2596
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 LE JEUNE RD STE 2
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4613
Country	:	US
Telephone Number	:	305-883-5188
Fax Number	:

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

Provider Enumeration Date	:	03/24/2018
Last Update Date	:	03/24/2018

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