Provider Demographics
NPI:1912310228
Name:LOSACCO, ANTHONY (BS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:LOSACCO
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 CHARLESTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5503
Mailing Address - Country:US
Mailing Address - Phone:727-859-8919
Mailing Address - Fax:
Practice Address - Street 1:4314 CHARLESTON ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5503
Practice Address - Country:US
Practice Address - Phone:727-859-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management