Healthcare Provider Details

I. General information

NPI: 1386140499
Provider Name (Legal Business Name): ANNA KOTLARZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

32973 CAMINITO LORCA
TEMECULA CA
92592-3390
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-1447
  • Fax:
Mailing address:
  • Phone: 850-619-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA178506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0006977
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: