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General NPI Number Information
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NPI Number | 1982511242
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Entity Type | Organization
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Legal Business Name | COSA SAN DIEGO
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 1112 SEACOAST DR APT 9
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-3131
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Country | US
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Telephone | 503-318-5438
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 SEACOAST DR APT 9
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-3131
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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 | DIRECTOR OF OPERATIONS
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Name | MR. THOMAS CORNWELL
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Credential |
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Telephone | 619-871-4924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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