Basic Information
Provider Information | |||||||||
NPI: | 1063457448 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SOUZA & ASSOCIATES, INC., P.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 444 | ||||||||
Address2: |   | ||||||||
City: | SOUTH BOSTON | ||||||||
State: | VA | ||||||||
PostalCode: | 245920444 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4345723323 | ||||||||
FaxNumber: | 4345726716 | ||||||||
Practice Location | |||||||||
Address1: | 2204 WILBORN AVE | ||||||||
Address2: |   | ||||||||
City: | SOUTH BOSTON | ||||||||
State: | VA | ||||||||
PostalCode: | 245921645 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4345173139 | ||||||||
FaxNumber: | 4345726716 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/18/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SOUZA | ||||||||
AuthorizedOfficialFirstName: | CESAR | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 4345723323 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 0249A | 01 | NC | NORTH CAROLINA BLUE CROSS | OTHER | 890249A | 05 | NC |   | MEDICAID |