1578695581 NPI number — LINDA COSENZA CLS

Table of content: LINDA COSENZA CLS (NPI 1578695581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578695581 NPI number — LINDA COSENZA CLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSENZA
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CLS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578695581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
177 BOVET RD FL 6
Provider Second Line Business Mailing Address:
ATTN: CD BILLING
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94402-3116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-255-9279
Provider Business Mailing Address Fax Number:
701-222-4142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4892 SCREECH OWL CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95762-8073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-600-3554
Provider Business Practice Location Address Fax Number:
701-222-4142
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CL10911 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LAB698660 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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