Provider Demographics
NPI:1497965941
Name:KOSOBUCKI, TRINH NGOC (NP)
Entity Type:Individual
Prefix:MRS
First Name:TRINH
Middle Name:NGOC
Last Name:KOSOBUCKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39765 DATE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2005
Mailing Address - Country:US
Mailing Address - Phone:951-894-4665
Mailing Address - Fax:951-894-5178
Practice Address - Street 1:39765 DATE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2005
Practice Address - Country:US
Practice Address - Phone:951-894-4665
Practice Address - Fax:951-894-5178
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA578255OtherRN LICENSE
CA16994OtherNP LICENSE