Provider Demographics
NPI:1003289349
Name:COSSA LLC
Entity Type:Organization
Organization Name:COSSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SURGICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:ARMANDO
Authorized Official - Last Name:COSSA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:469-293-7331
Mailing Address - Street 1:1533 CRESTED BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7529
Mailing Address - Country:US
Mailing Address - Phone:469-293-7331
Mailing Address - Fax:
Practice Address - Street 1:1533 CRESTED BUTTE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-7529
Practice Address - Country:US
Practice Address - Phone:469-293-7331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty