Provider Demographics
NPI:1992181457
Name:COSLET, KALIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:
Last Name:COSLET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 GROSSMONT CENTER DR STE 256
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3098
Mailing Address - Country:US
Mailing Address - Phone:619-462-3131
Mailing Address - Fax:619-462-1731
Practice Address - Street 1:5565 GROSSMONT CENTER DR, BUILDING 3
Practice Address - Street 2:SUITE 256
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3098
Practice Address - Country:US
Practice Address - Phone:619-462-3131
Practice Address - Fax:619-462-1731
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant