Provider Demographics
NPI:1417781253
Name:COGNITIVE DIAGNOSTIC SOLUTIONS
Entity type:Organization
Organization Name:COGNITIVE DIAGNOSTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-835-8678
Mailing Address - Street 1:4301 S PINE ST STE 30-2
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-9123
Mailing Address - Country:US
Mailing Address - Phone:425-996-8592
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST STE 30-2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-9123
Practice Address - Country:US
Practice Address - Phone:425-996-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty