MEDICARE: CARMEN COTSIS PA-C

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	363A00000X	Physician Assistant	57001	CA

General Provider Information

NPI Number	:	1801456785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN COTSIS PA-C

Provider Business Mailing Address
First Line	:	2050 S BLOSSER RD
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-7310
Country	:	US
Telephone Number	:	805-361-8030
Fax Number	:	805-361-8097

Provider Business Practice Location Address
First Line	:	490 BELL ST UNIT 103
Second Line	:
City	:	LOS ALAMOS
State	:	CA
Zip	:	93440-5002
Country	:	US
Telephone Number	:	805-344-4994
Fax Number	:	805-344-4996

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	11/17/2025

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