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General NPI Number Information
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NPI Number | 1023516812
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Entity Type | Individual
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Provider Name | KEVIN COSICO VALDEABELLA
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Gender | Male
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 19465 MEEKLAND AVE
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City | HAYWARD
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State | CA
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Zip | 94541-1942
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Country | US
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Telephone | 510-940-3375
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Fax |
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Provider Business Mailing Address
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Address Line | 19465 MEEKLAND AVE
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City | HAYWARD
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State | CA
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Zip | 94541-1942
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number | 00023261
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License Number State | CA
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