MEDICARE: ANTONIA LEIGH COTWRIGHT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	036-118703	IL

General Provider Information

NPI Number	:	1003014523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIA LEIGH COTWRIGHT D.O.

Provider Business Mailing Address
First Line	:	510 N PROSPECT AVE STE 320
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3032
Country	:	US
Telephone Number	:	310-376-2716
Fax Number	:	310-374-9163

Provider Business Practice Location Address
First Line	:	510 N PROSPECT AVE STE 320
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3032
Country	:	US
Telephone Number	:	310-376-2716
Fax Number	:	310-374-9163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	12/08/2021

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