Provider Demographics
NPI:1538392642
Name:SOSA, CARMELA ELAINE (MD)
Entity type:Individual
Prefix:
First Name:CARMELA
Middle Name:ELAINE
Last Name:SOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMELA
Other - Middle Name:ELAINE
Other - Last Name:UNGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL # SC05
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-6425
Mailing Address - Fax:559-353-6441
Practice Address - Street 1:9300 VALLEY CHILDRENS PL # MB01
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-353-6425
Practice Address - Fax:559-353-6441
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95150208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSO7315461Medicaid
CA1538392642Medicaid