Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | G67567 | CA |
NPI | 1619953643 |
---|---|
Provider Name | David Cosca |
First Address | Sacramento, CA 95816 |
Second Address | Sacramento, CA 95816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 20/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F02823 | (02) | CA |