Healthcare Provider Details

I. General information

NPI: 1568594653
Provider Name (Legal Business Name): CAROL ANN JOSEPHS-COWAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4746 BARRANCA PKWY
IRVINE CA
92604-4728
US

IV. Provider business mailing address

4746 BARRANCA PKWY
IRVINE CA
92604-4728
US

V. Phone/Fax

Practice location:
  • Phone: 949-653-2959
  • Fax: 949-653-5589
Mailing address:
  • Phone: 949-653-2959
  • Fax: 949-653-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number367702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: