Individual provider Active NPI

Jose M Sosa, DDS

  • General Practice Dentistry
  • Vista, CA
National Provider Identifier
1750579371
Registry record updated Apr 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
56379 Issued in CA
Practice address
1235 W Vista Way Ste L
Vista, CA 92083-6234
Phone
(760) 730-0168
Fax
(760) 730-0189
NPI assigned
Oct 9, 2007
Last updated
Apr 4, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 56379 CA Primary

Addresses

Primary practice location

1235 W Vista Way Ste L
Vista, CA 92083-6234

Mailing address

1235 W Vista Way Ste L
Vista, CA 92083-6234
Phone (760) 730-0168

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190910003788 CA Practitioner - Oral SurgeryPractitioner - Dentist 2365771763

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
56379CAMDPharmacist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522800000000",
    "number": "1750579371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 W VISTA WAY STE L",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836234",
            "telephone_number": "760-730-0168",
            "fax_number": "760-730-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 W VISTA WAY STE L",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836234",
            "telephone_number": "760-730-0168",
            "fax_number": "760-730-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOSA",
        "first_name": "JOSE",
        "middle_name": "M",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-09",
        "last_updated": "2018-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "56379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.