Healthcare Provider Details

I. General information

NPI: 1144667429
Provider Name (Legal Business Name): COSHIRE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 KNOWLES DR STE 203
LOS GATOS CA
95032-1549
US

IV. Provider business mailing address

555 KNOWLES DR STE 203
LOS GATOS CA
95032-1549
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-4959
  • Fax: 405-358-8692
Mailing address:
  • Phone: 408-356-4959
  • Fax: 405-358-8692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES LILJA
Title or Position: OWNER PROVIDER
Credential: M.D.
Phone: 408-356-4959