Healthcare Provider Details

I. General information

NPI: 1942450747
Provider Name (Legal Business Name): EDGAR Z. COSME, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14662 NEWPORT AVE
TUSTIN CA
92780-6064
US

IV. Provider business mailing address

PO BOX 888443
LOS ANGELES CA
90088-8443
US

V. Phone/Fax

Practice location:
  • Phone: 714-269-3995
  • Fax:
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDGAR Z. COSME
Title or Position: OWNER
Credential: M.D.
Phone: 714-269-3995