Healthcare Provider Details

I. General information

NPI: 1407215395
Provider Name (Legal Business Name): SHYKISH COSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 ATLANTIC AVE
LONG BEACH CA
90807-2803
US

IV. Provider business mailing address

4335 ATLANTIC AVE
LONG BEACH CA
90807-2803
US

V. Phone/Fax

Practice location:
  • Phone: 562-216-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number38349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: