Healthcare Provider Details

I. General information

NPI: 1841367091
Provider Name (Legal Business Name): MARCOS KOTOYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NORTH VERMONT AVENUE SUITE 804
LOS ANGELES CA
90027
US

IV. Provider business mailing address

1300 NORTH VERMONT AVENUE SUITE 804
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 323-662-9711
  • Fax: 323-662-9731
Mailing address:
  • Phone: 323-662-9711
  • Fax: 323-662-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA30078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: