Healthcare Provider Details

I. General information

NPI: 1659548576
Provider Name (Legal Business Name): ESTEBAN COSS CST GFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEVE COSS CST CFA

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MATLOCK
ARLINGTON TX
76015
US

IV. Provider business mailing address

5812 STORM DRIVE
WATAUGA TX
76148
US

V. Phone/Fax

Practice location:
  • Phone: 817-472-4856
  • Fax:
Mailing address:
  • Phone: 817-428-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number96612
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: