Healthcare Provider Details

I. General information

NPI: 1528570678
Provider Name (Legal Business Name): DOSSIER HEALTH MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 N BRAND BLVD STE 200-106
GLENDALE CA
91203-4614
US

IV. Provider business mailing address

138 N BRAND BLVD STE 200-106
GLENDALE CA
91203-4614
US

V. Phone/Fax

Practice location:
  • Phone: 818-823-4352
  • Fax: 818-230-9029
Mailing address:
  • Phone: 818-823-4352
  • Fax: 818-230-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA82437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: JAMES KOSTOS
Title or Position: MANAGER
Credential:
Phone: 818-823-4352