Provider Demographics
NPI:1265147912
Name:COSGRIFF, SIRINA ROSE
Entity type:Individual
Prefix:
First Name:SIRINA
Middle Name:ROSE
Last Name:COSGRIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 OXFORD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2666
Mailing Address - Country:US
Mailing Address - Phone:805-574-5746
Mailing Address - Fax:
Practice Address - Street 1:127 OXFORD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2666
Practice Address - Country:US
Practice Address - Phone:805-574-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician