Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME129645 | FL |
NPI | 1053491498 |
---|---|
Provider Name | Carmen C. Cosio |
First Address | St Petersburg, FL 33701-4634 |
Second Address | Tampa, FL 33613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 21/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100078400 | (05) | FL |
F39513 | (02) |