Healthcare Provider Details

I. General information

NPI: 1902008071
Provider Name (Legal Business Name): JOSEPH J KOZINSKI MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21252 ONAKNOLL DR
PERRIS CA
92570-9565
US

IV. Provider business mailing address

21252 ONAKNOLL DR
PERRIS CA
92570-9565
US

V. Phone/Fax

Practice location:
  • Phone: 951-640-0007
  • Fax: 951-789-0416
Mailing address:
  • Phone: 951-640-0007
  • Fax: 951-789-0416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: