Provider Demographics
NPI:1659674620
Name:KOSSOL, GABRIEL CHARLES
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:CHARLES
Last Name:KOSSOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9372 DESCHUTES RD
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-9763
Mailing Address - Country:US
Mailing Address - Phone:530-547-2020
Mailing Address - Fax:
Practice Address - Street 1:9372 DESCHUTES RD
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-9763
Practice Address - Country:US
Practice Address - Phone:530-547-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist