Provider Demographics
NPI:1578909685
Name:COBA, KESLY PAOLA (MS)
Entity Type:Individual
Prefix:MS
First Name:KESLY
Middle Name:PAOLA
Last Name:COBA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13777 45TH AVE APT 1M
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4079
Mailing Address - Country:US
Mailing Address - Phone:718-358-4675
Mailing Address - Fax:
Practice Address - Street 1:13777 45TH AVE APT 1M
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4079
Practice Address - Country:US
Practice Address - Phone:718-358-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist