Individual
MR. DANIEL JEREMY COSGROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16311 VENTURA BLVD, STE 800, ENCINO, CA 91436-2124
(878) 906-0635
(818) 906-7303
Mailing address
16311 VENTURA BLVD, STE 800, ENCINO, CA 91436-2124
(878) 906-0635
(818) 906-7303
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
S64348
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A643480
—
CA
01
—
222046862
BLUE SHIELD
CA
01
—
P00647439
RAILROAD MEDICARE PTAN
CA
Enumeration date
11/09/2005
Last updated
07/08/2010
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