Provider Demographics
NPI:1619953643
Name:COSCA, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COSCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 J ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-734-6805
Mailing Address - Fax:916-734-6806
Practice Address - Street 1:2805 J ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-734-6805
Practice Address - Fax:916-734-6806
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG67567204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G675670Medicare PIN
CAF02823Medicare UPIN