Healthcare Provider Details

I. General information

NPI: 1972679413
Provider Name (Legal Business Name): EVA-RENATE CHRISTINE COTTER L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8954 CARLTON HILLS BLVD
SANTEE CA
92071-2932
US

IV. Provider business mailing address

16730 WIKIUP RD
RAMONA CA
92065-4189
US

V. Phone/Fax

Practice location:
  • Phone: 619-667-9931
  • Fax: 619-562-9871
Mailing address:
  • Phone: 619-667-9931
  • Fax: 619-562-9871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: