Healthcare Provider Details

I. General information

NPI: 1881717635
Provider Name (Legal Business Name): CARLOS A COSENZA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ALVARADO STREET #602
LOS ANGELES CA
90057-2354
US

IV. Provider business mailing address

19329 CALADERO STREET
TARZANA CA
91356-5501
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-2930
  • Fax: 213-413-7734
Mailing address:
  • Phone: 818-986-8171
  • Fax: 818-986-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA053355
License Number StateCA

VIII. Authorized Official

Name: CARLOS ALBERTO COSENZA
Title or Position: PRESIDENT
Credential: MD
Phone: 213-393-1979