Healthcare Provider Details

I. General information

NPI: 1659875060
Provider Name (Legal Business Name): PAOLA MONTSERRAT COTA PHELAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5153
  • Fax: 415-476-5354
Mailing address:
  • Phone: 415-476-5153
  • Fax: 415-476-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A17857
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA17857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: