Healthcare Provider Details

I. General information

NPI: 1366093130
Provider Name (Legal Business Name): KOTOBI & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 W COURTYARD DRIVE BLDG 1, SUITE 150
AUSTIN TX
78730
US

IV. Provider business mailing address

6101 W COURTYARD DRIVE BLDG 1, SUITE 150
AUSTIN TX
78730
US

V. Phone/Fax

Practice location:
  • Phone: 512-455-8888
  • Fax: 512-455-8888
Mailing address:
  • Phone: 512-455-8888
  • Fax: 512-455-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTENA KOTOBI
Title or Position: CO OWNER
Credential:
Phone: 801-946-1178