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NPI Code Detail

MEDICARE: MR. MATTHEW JOHN KOSEL PA-C

MEDICARE: MR. MATTHEW JOHN KOSEL PA-C
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
1363A00000XPhysician AssistantPA17101CA

General Provider Information

NPI Number : 1316947302
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW JOHN KOSEL PA-C
Provider Business Mailing Address
First Line : 150 VALPREDA RD
Second Line :
City : SAN MARCOS
State : CA
Zip : 92069-2973
Country : US
Telephone Number : 760-736-6700
Fax Number :
Provider Business Practice Location Address
First Line : 150 VALPREDA RD
Second Line :
City : SAN MARCOS
State : CA
Zip : 92069-2973
Country : US
Telephone Number : 760-789-1223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2005
Last Update Date : 10/16/2014

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