Provider Demographics
NPI:1386839058
Name:KOS, NIRVANA GABRIELA (DR, EDD, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:NIRVANA
Middle Name:GABRIELA
Last Name:KOS
Suffix:
Gender:F
Credentials:DR, EDD, BCBA, LBA
Other - Prefix:
Other - First Name:NIRVANA
Other - Middle Name:
Other - Last Name:KOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DR, BCBA, LBA
Mailing Address - Street 1:8445 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3270
Mailing Address - Country:US
Mailing Address - Phone:786-362-4128
Mailing Address - Fax:
Practice Address - Street 1:8445 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3270
Practice Address - Country:US
Practice Address - Phone:786-362-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812138900Medicaid