Provider Demographics
NPI:1063235703
Name:SOSA, ADA
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:SOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADA LINETH
Other - Middle Name:
Other - Last Name:GARCIA SOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2516 SHANE DR
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3125
Mailing Address - Country:US
Mailing Address - Phone:443-534-5627
Mailing Address - Fax:
Practice Address - Street 1:2855 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1128
Practice Address - Country:US
Practice Address - Phone:510-541-1026
Practice Address - Fax:510-835-1062
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker