Provider Demographics
NPI:1841589181
Name:LOSASSO, PATRICK (CSCS, CPT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:LOSASSO
Suffix:
Gender:M
Credentials:CSCS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 MONTECITO DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1651
Mailing Address - Country:US
Mailing Address - Phone:323-422-9794
Mailing Address - Fax:323-222-6952
Practice Address - Street 1:1167 MONTECITO DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-1651
Practice Address - Country:US
Practice Address - Phone:323-422-9794
Practice Address - Fax:323-222-6952
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT67767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist