Healthcare Provider Details

I. General information

NPI: 1750497053
Provider Name (Legal Business Name): LLOYD COTTON RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 E SANTA ANA CANYON RD
ANAHEIM CA
92807-2365
US

IV. Provider business mailing address

6326 E SANTA ANA CANYON RD
ANAHEIM CA
92807-2365
US

V. Phone/Fax

Practice location:
  • Phone: 714-526-3248
  • Fax: 714-526-3240
Mailing address:
  • Phone: 714-526-3248
  • Fax: 714-526-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOPT120040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: