Provider Demographics
NPI:1659548576
Name:COSS, ESTEBAN (CST GFA)
Entity Type:Individual
Prefix:MR
First Name:ESTEBAN
Middle Name:
Last Name:COSS
Suffix:
Gender:M
Credentials:CST GFA
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:COSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CST CFA
Mailing Address - Street 1:5812 STORM DRIVE
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148
Mailing Address - Country:US
Mailing Address - Phone:817-428-7353
Mailing Address - Fax:
Practice Address - Street 1:3301 MATLOCK
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015
Practice Address - Country:US
Practice Address - Phone:817-472-4856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96612246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant