Provider Demographics
NPI:1962288548
Name:SOSA LLULL, ANISLEY
Entity type:Individual
Prefix:
First Name:ANISLEY
Middle Name:
Last Name:SOSA LLULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5535
Mailing Address - Country:US
Mailing Address - Phone:786-635-7972
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 8
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00986-0008
Practice Address - Country:US
Practice Address - Phone:787-626-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028337363LF0000X
PR17299I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily