Healthcare Provider Details

I. General information

NPI: 1174078091
Provider Name (Legal Business Name): DAVID KOSAREFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2016
Last Update Date: 08/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N EUCLID ST STE 680
ANAHEIM CA
92801-5509
US

IV. Provider business mailing address

10226 MONTEREY ST
BELLFLOWER CA
90706-6732
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-0010
  • Fax:
Mailing address:
  • Phone: 562-547-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number291947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: