Provider Demographics
NPI:1235421389
Name:KOSSMAN, ALENA
Entity Type:Individual
Prefix:MRS
First Name:ALENA
Middle Name:
Last Name:KOSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 GEARY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2253
Mailing Address - Country:US
Mailing Address - Phone:415-221-6800
Mailing Address - Fax:415-221-6900
Practice Address - Street 1:5616 GEARY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2253
Practice Address - Country:US
Practice Address - Phone:415-221-6800
Practice Address - Fax:415-221-6900
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist