Provider Demographics
NPI:1548445216
Name:RENEE COTTER MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:RENEE COTTER MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:818-887-5008
Mailing Address - Street 1:7301 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1904
Mailing Address - Country:US
Mailing Address - Phone:818-887-5008
Mailing Address - Fax:818-887-5577
Practice Address - Street 1:7301 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 304
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1904
Practice Address - Country:US
Practice Address - Phone:818-887-5008
Practice Address - Fax:818-887-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03715ZOtherBLUE SHIELD
W19255Medicare PIN