Provider Demographics
NPI:1447526694
Name:COSENZA, GUSTAVO ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ENRIQUE
Last Name:COSENZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3A. CALLE A 8-51 ZONA 10
Mailing Address - Street 2:
Mailing Address - City:GUATEMALA
Mailing Address - State:GUATEMALA
Mailing Address - Zip Code:01010
Mailing Address - Country:GT
Mailing Address - Phone:005022-334-1464
Mailing Address - Fax:005022-334-6007
Practice Address - Street 1:3A. CALLE A 8-51 ZONA 10
Practice Address - Street 2:
Practice Address - City:GUATEMALA
Practice Address - State:GUATEMALA
Practice Address - Zip Code:01010
Practice Address - Country:GT
Practice Address - Phone:005022-334-1464
Practice Address - Fax:005022-334-6007
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ17252084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty