Healthcare Provider Details

I. General information

NPI: 1104018928
Provider Name (Legal Business Name): KHULOOD Y. COTTA M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4946 FLORENCE AVE
BELL CA
90201-4319
US

IV. Provider business mailing address

4946 FLORENCE AVE
BELL CA
90201-4319
US

V. Phone/Fax

Practice location:
  • Phone: 323-773-0591
  • Fax:
Mailing address:
  • Phone: 323-773-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40215
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA36591
License Number StateCA

VIII. Authorized Official

Name: MRS. ROSA MARTINEZ
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 323-773-0591