Provider Demographics
NPI:1518460112
Name:EZE, COSMAS (ADMINISTRATOR)
Entity Type:Individual
Prefix:MR
First Name:COSMAS
Middle Name:
Last Name:EZE
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4709
Mailing Address - Country:US
Mailing Address - Phone:702-902-5400
Mailing Address - Fax:702-902-5401
Practice Address - Street 1:4723 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4742
Practice Address - Country:US
Practice Address - Phone:702-902-5400
Practice Address - Fax:702-902-5401
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2019-11-27
Deactivation Date:2018-11-07
Deactivation Code:
Reactivation Date:2019-11-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health