MEDICARE: COELITHIA NICOLE SOSA PA

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	363A00000X	Physician Assistant	65013	CA

General Provider Information

NPI Number	:	1992560437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COELITHIA NICOLE SOSA PA

Provider Business Mailing Address
First Line	:	9200 FARMSTEAD CIR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-4415
Country	:	US
Telephone Number	:	954-625-5761
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 DOUGLAS BLVD
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-5902
Country	:	US
Telephone Number	:	916-938-2912
Fax Number	:	916-771-6338

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

Provider Enumeration Date	:	02/14/2024
Last Update Date	:	01/20/2026

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Directions to “ COELITHIA NICOLE SOSA PA” Practice Location

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