Provider Demographics
NPI:1215496096
Name:SOSA RAMIREZ, CARLOS VINICIO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:VINICIO
Last Name:SOSA RAMIREZ
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 1:40892 CAMELLIA DR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-2410
Mailing Address - Country:US
Mailing Address - Phone:909-773-8658
Mailing Address - Fax:
Practice Address - Street 1:40892 CAMELLIA DR
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-2410
Practice Address - Country:US
Practice Address - Phone:909-773-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty