Provider Demographics
NPI:1386482503
Name:COSIP, MARISTELLA J (FNP)
Entity type:Individual
Prefix:
First Name:MARISTELLA
Middle Name:J
Last Name:COSIP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 E HARPER ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-7398
Mailing Address - Country:US
Mailing Address - Phone:626-327-5430
Mailing Address - Fax:
Practice Address - Street 1:2624 E HARPER ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-7398
Practice Address - Country:US
Practice Address - Phone:909-942-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine