Healthcare Provider Details

I. General information

NPI: 1497808950
Provider Name (Legal Business Name): COTY P HO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE E218
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR STE E218
PALM SPRINGS CA
92262-4800
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4749
  • Fax: 760-416-4903
Mailing address:
  • Phone: 760-416-4749
  • Fax: 760-416-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number28280
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberBH6437075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: