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General NPI Number Information
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NPI Number | 1083636203
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Entity Type | Individual
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Provider Name | JENNIFER R KOSOVA PAC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 1328 22ND STREET ER
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 214-455-5366
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Fax |
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Provider Business Mailing Address
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Address Line | 1439 N HIGHLAND AVE STE 1059
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City | LOS ANGELES
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State | CA
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Zip | 90028-7622
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Country | US
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Telephone | 214-455-5366
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Fax | 323-336-8769
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02208
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA20131
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License Number State | CA
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