Provider Demographics
NPI:1073580999
Name:COBASKO, DAVID FRANK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANK
Last Name:COBASKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MARIN ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-495-6702
Mailing Address - Fax:805-495-6195
Practice Address - Street 1:555 MARIN ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-495-6702
Practice Address - Fax:805-495-6195
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG884912084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169121401Medicaid
TX169121401Medicaid
TXG43827Medicare UPIN
G43827Medicare UPIN