MEDICARE: SAMUEL COTTON JR.

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	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1285335398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL COTTON JR.

Provider Business Mailing Address
First Line	:	473 E. CARNEGIE DRIVE
Second Line	:	200
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408
Country	:	US
Telephone Number	:	909-277-6090
Fax Number	:

Provider Business Practice Location Address
First Line	:	66176 DESERT VIEW AVE
Second Line	:
City	:	DESERT HOT SPRINGS
State	:	CA
Zip	:	92240-3844
Country	:	US
Telephone Number	:	760-898-3014
Fax Number	:

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

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	01/15/2025

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