Provider Demographics
NPI:1194347831
Name:SOSA GARCIA, ETHEL LIZA (SA-C)
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:LIZA
Last Name:SOSA GARCIA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 PRESIDENTIAL DR APT B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-3347
Mailing Address - Country:US
Mailing Address - Phone:302-252-8470
Mailing Address - Fax:
Practice Address - Street 1:221 PRESIDENTIAL DR APT B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-3347
Practice Address - Country:US
Practice Address - Phone:302-252-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE19-338246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant