Provider Demographics
NPI:1720057516
Name:KOZAK, VALERIA I (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIA
Middle Name:I
Last Name:KOZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14642 NEWPORT AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6057
Mailing Address - Country:US
Mailing Address - Phone:714-838-0022
Mailing Address - Fax:714-838-0060
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-838-0022
Practice Address - Fax:714-838-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89502208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine