Provider Demographics
NPI:1699044636
Name:COSSETTE, MARISELA VIVAS (RPH)
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:VIVAS
Last Name:COSSETTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 ARMAGA SPRING RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4852
Mailing Address - Country:US
Mailing Address - Phone:310-377-3413
Mailing Address - Fax:
Practice Address - Street 1:9750 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6422
Practice Address - Country:US
Practice Address - Phone:818-899-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist