Provider Demographics
NPI:1316544463
Name:KOUASSI, ATIEN MARIUS (RCP, RRT, CPFT)
Entity Type:Individual
Prefix:MR
First Name:ATIEN
Middle Name:MARIUS
Last Name:KOUASSI
Suffix:
Gender:M
Credentials:RCP, RRT, CPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5366 KANKAKEE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-3058
Mailing Address - Country:US
Mailing Address - Phone:916-248-1026
Mailing Address - Fax:
Practice Address - Street 1:5366 KANKAKEE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-3058
Practice Address - Country:US
Practice Address - Phone:916-248-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135329225B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function Technologist