Healthcare Provider Details

I. General information

NPI: 1962602870
Provider Name (Legal Business Name): EDINA GALE KOSSOW ECHOCARDIOGRAPHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9648 US HIGHWAY 301 S #208
RIVERVIEW FL
33578-5442
US

IV. Provider business mailing address

9648 US HIGHWAY 301 S #208
RIVERVIEW FL
33578-5442
US

V. Phone/Fax

Practice location:
  • Phone: 813-335-1127
  • Fax:
Mailing address:
  • Phone: 813-335-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: