Healthcare Provider Details

I. General information

NPI: 1912820812
Provider Name (Legal Business Name): DAQUAN LUSHUNE COSBY LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703
US

IV. Provider business mailing address

2615 E CLINTON AVE
FRESNO CA
93703
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax: 559-228-6983
Mailing address:
  • Phone: 559-225-6100
  • Fax: 559-228-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number712146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: