Healthcare Provider Details

I. General information

NPI: 1174203046
Provider Name (Legal Business Name): HALA KOTOB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9112 ORANGEWOOD AVE
GARDEN GROVE CA
92841-2057
US

IV. Provider business mailing address

9112 ORANGEWOOD AVE
GARDEN GROVE CA
92841-2057
US

V. Phone/Fax

Practice location:
  • Phone: 949-835-2926
  • Fax:
Mailing address:
  • Phone: 949-835-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: