Healthcare Provider Details

I. General information

NPI: 1013210848
Provider Name (Legal Business Name): JACOB DANIEL KOSEKI MM, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S MAPLE AVE
TEMPE AZ
85281-8664
US

IV. Provider business mailing address

1210 S MAPLE AVE
TEMPE AZ
85281-8664
US

V. Phone/Fax

Practice location:
  • Phone: 808-375-0423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberD06620306
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: