Provider Demographics
NPI:1497490627
Name:SOSA, HUGO (SUDCC II # 7329)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:SOSA
Suffix:
Gender:M
Credentials:SUDCC II # 7329
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SPAANS DR STE CDANDF
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8609
Mailing Address - Country:US
Mailing Address - Phone:209-749-0627
Mailing Address - Fax:
Practice Address - Street 1:750 SPAANS DR STE CDANDF
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8609
Practice Address - Country:US
Practice Address - Phone:209-744-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7329101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator