Provider Demographics
NPI:1881717635
Name:CARLOS A COSENZA MD INC
Entity type:Organization
Organization Name:CARLOS A COSENZA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:COSENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-393-1979
Mailing Address - Street 1:19329 CALADERO STREET
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5501
Mailing Address - Country:US
Mailing Address - Phone:818-986-8171
Mailing Address - Fax:818-986-7320
Practice Address - Street 1:201 S ALVARADO STREET
Practice Address - Street 2:#602
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2354
Practice Address - Country:US
Practice Address - Phone:213-413-2930
Practice Address - Fax:213-413-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053355208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A533551Medicaid
G70998Medicare UPIN
A53355Medicare ID - Type Unspecified