Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 28915 | CA |
NPI | 1346651262 |
---|---|
Provider Name | Dr. Stephen Cotter |
First Address | Escondido, CA 92025-7653 |
Second Address | Escondido, CA 92025-7653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 13/05/2014 |