Provider Demographics
NPI:1902866189
Name:MOUSSA, SOSAN L (MD)
Entity type:Individual
Prefix:DR
First Name:SOSAN
Middle Name:L
Last Name:MOUSSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-382-1205
Mailing Address - Fax:
Practice Address - Street 1:1628 N ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3321
Practice Address - Country:US
Practice Address - Phone:520-325-8000
Practice Address - Fax:520-325-8616
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27593173000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH09182Medicare UPIN