Healthcare Provider Details

I. General information

NPI: 1376691394
Provider Name (Legal Business Name): KATHERINE ANN COTTON PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CLAY ST
SAN FRANCISCO CA
94115-1931
US

IV. Provider business mailing address

120 BURTON CT
DANVILLE CA
94526-5211
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-1298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number15261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: