Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 7566 | MT |
NPI | 1013054964 |
---|---|
Provider Name | Ernest Peter Kotsos |
First Address | San Diego, CA 92131-2291 |
Second Address | San Diego, CA 92131-2291 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |