Provider Demographics
NPI:1437355948
Name:COZZOLINO, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:COZZOLINO
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 1:614 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1048
Mailing Address - Country:US
Mailing Address - Phone:408-494-1570
Mailing Address - Fax:
Practice Address - Street 1:614 TULLY ROAD
Practice Address - Street 2:NARVAEZ MENTAL HEALTH
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111
Practice Address - Country:US
Practice Address - Phone:408-494-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA650942084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GQ750PMedicare PIN
GQ750QMedicare PIN
GQ750XMedicare PIN
GQ750WMedicare PIN
CAH75993Medicare UPIN
GQ750VMedicare PIN
GQ750RMedicare PIN
CAGQ750YMedicare PIN
GQ750SMedicare PIN
GQ750ZMedicare PIN
GQ750TMedicare PIN
GQ750UMedicare PIN
CA00A650940Medicare PIN