Healthcare Provider Details

I. General information

NPI: 1821907007
Provider Name (Legal Business Name): LEAH COTTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41965 BIG BEAR BLVD. 41965 BIG BEAR BLVD.
BIG BEAR LAKE CA
92315
US

IV. Provider business mailing address

PO BOX 6609
BIG BEAR LAKE CA
92315-6609
US

V. Phone/Fax

Practice location:
  • Phone: 909-878-2326
  • Fax:
Mailing address:
  • Phone: 909-878-2326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: