Provider Demographics
NPI:1457005928
Name:COSICO, SARRAH JANE PEREZ (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SARRAH JANE
Middle Name:PEREZ
Last Name:COSICO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S CENTRAL AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4647
Mailing Address - Country:US
Mailing Address - Phone:818-500-8739
Mailing Address - Fax:818-500-0957
Practice Address - Street 1:710 S CENTRAL AVE STE 340
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4647
Practice Address - Country:US
Practice Address - Phone:818-500-8739
Practice Address - Fax:818-500-0957
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022073363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily