Healthcare Provider Details

I. General information

NPI: 1639199896
Provider Name (Legal Business Name): DAVID V. COSSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 615E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST SUITE 615E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-8132
  • Fax: 310-659-3815
Mailing address:
  • Phone: 310-652-8132
  • Fax: 310-659-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG035121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: