MEDICARE: PELVICSANITY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1225549223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELVICSANITY, INC.

Provider Business Mailing Address
First Line	:	25401 CABOT RD STE 121
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25401 CABOT RD STE 121
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5530
Country	:	US
Telephone Number	:	949-393-1113
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICOLE DANIELLE COZEAN
Credential	:	DPT
Telephone Number	:	949-393-1113

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	10/17/2017

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