Provider Demographics
NPI:1063380327
Name:SOSA, GERARDO RJ
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:RJ
Last Name:SOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20508 SW ROY ROGERS RD # C115
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9932
Mailing Address - Country:US
Mailing Address - Phone:503-905-3585
Mailing Address - Fax:503-905-3586
Practice Address - Street 1:20508 SW ROY ROGERS RD # C115
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9932
Practice Address - Country:US
Practice Address - Phone:503-905-3585
Practice Address - Fax:503-905-3586
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist