Healthcare Provider Details

I. General information

NPI: 1437355948
Provider Name (Legal Business Name): ANTHONY COZZOLINO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 TULLY ROAD NARVAEZ MENTAL HEALTH
SAN JOSE CA
95111
US

IV. Provider business mailing address

614 TULLY RD
SAN JOSE CA
95111-1048
US

V. Phone/Fax

Practice location:
  • Phone: 408-494-1570
  • Fax:
Mailing address:
  • Phone: 408-494-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA65094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: