Provider Demographics
NPI:1548391352
Name:KOSICH-ENKO, SVETLANA (LAC, PHD)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:KOSICH-ENKO
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4252
Mailing Address - Country:US
Mailing Address - Phone:661-322-0240
Mailing Address - Fax:661-322-0280
Practice Address - Street 1:2020 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4252
Practice Address - Country:US
Practice Address - Phone:661-322-0240
Practice Address - Fax:661-322-0280
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA7909171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist