Provider Demographics
NPI:1306571138
Name:KOZAKOWSKI, KATHRYN CONNELLY
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CONNELLY
Last Name:KOZAKOWSKI
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 1:10815 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4114
Mailing Address - Country:US
Mailing Address - Phone:310-559-4171
Mailing Address - Fax:
Practice Address - Street 1:UCLA HEALTH 757 WESTWOOD PLAZA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-4114
Practice Address - Country:US
Practice Address - Phone:424-467-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-17
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021683363LA2100X
CA5018364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care