Basic Information
| Provider Information | |||||||||
| NPI: | 1144288101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOSNOV | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5342 DUDLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | MCCLELLAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956521012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5342 DUDLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | MCCLELLAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956521012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | ME9663 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.