Healthcare Provider Details

I. General information

NPI: 1184967861
Provider Name (Legal Business Name): HALEIGH COLE KOTTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCLA EMERGENCY MEDICINE 924 WESTWOOD BLVD. SUITE 300
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

UCLA EMERGENCY MEDICINE 924 WESTWOOD BLVD. SUITE 300
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-0585
  • Fax:
Mailing address:
  • Phone: 310-794-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA133256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: