Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 165024 | CA |
NPI | 1003310020 |
---|---|
Provider Name | Mr. Collin Markham Cousins |
First Address | Los Angeles, CA 90033-1083 |
Second Address | Los Angeles, CA 90033-1083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2018 |
Last Update Date | 14/10/2021 |