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NPI Code Detail

MEDICARE: MARIE COTTON VASSILIADIS

MEDICARE: MARIE COTTON VASSILIADIS
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
1363LF0000XFamily Nurse Practitioner95026076CA

General Provider Information

NPI Number : 1871378091
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE COTTON VASSILIADIS
Provider Business Mailing Address
First Line : 4343 NIAGARA AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92107-2925
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4343 NIAGARA AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92107-2925
Country : US
Telephone Number : 208-599-4288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 08/28/2023

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Directions to “ MARIE COTTON VASSILIADIS ” Practice Location

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