Provider Demographics
NPI:1285169813
Name:COSS, MARIO (ND)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:COSS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S LONGMORE
Mailing Address - Street 2:APT 287
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-3174
Mailing Address - Country:US
Mailing Address - Phone:480-668-2815
Mailing Address - Fax:
Practice Address - Street 1:850 S LONGMORE
Practice Address - Street 2:APT 287
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-3174
Practice Address - Country:US
Practice Address - Phone:480-668-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1620175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath