Healthcare Provider Details

I. General information

NPI: 1669689832
Provider Name (Legal Business Name): ANN ELIZABETH KOTTLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13606 ARNOLD DR
GLEN ELLEN CA
95442-9318
US

IV. Provider business mailing address

13606 ARNOLD DR
GLEN ELLEN CA
95442-9318
US

V. Phone/Fax

Practice location:
  • Phone: 415-793-5987
  • Fax:
Mailing address:
  • Phone: 415-793-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberC37101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: