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1417352501
KOSE IKENASIO
SAN BERNARDINO, CA
NPI
1417352501
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: CA 73873)
Enumeration Date
2014-10-31
Last Update Date
2017-03-17
Business Address
-- KOSE IKENASIO ACSW, MSW
900 E GILBERT ST BLDG 5
SAN BERNARDINO, CA 92415-0911
Phone number: 909-387-7686
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Mailing Address
-- KOSE IKENASIO ACSW, MSW
PO BOX 3171
LAKEWOOD, CA 90711-3171
Phone number:
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