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General NPI Number Information
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NPI Number | 1962221119
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Entity Type | Organization
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Legal Business Name | COGDIVERSIFIED INC
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Dates
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Enumeration Date | 10/05/2024
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Last Update Date | 09/06/2025
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Provider Practice Location Address
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Address Line | 2022 VANCOUVER AVE # A
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City | MONTEREY PARK
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State | CA
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Zip | 91754-5908
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Country | US
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Telephone | 571-376-8348
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Fax |
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Provider Business Mailing Address
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Address Line | 2022 VANCOUVER AVE # A
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City | MONTEREY PARK
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State | CA
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Zip | 91754-5908
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Country | US
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Telephone | 571-376-8348
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TIANJIAO SUN
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Credential |
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Telephone | 571-376-8348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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