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General NPI Number Information
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NPI Number | 1396886172
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Entity Type | Organization
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Legal Business Name | DR JACQUELYN KOTARAC, M.D., INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3941 SAN DIMAS ST STE. 103A
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City | BAKERSFIELD
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State | CA
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Zip | 93301-5734
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Country | US
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Telephone | 661-322-3225
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Fax | 661-322-2997
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Provider Business Mailing Address
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Address Line | 3941 SAN DIMAS ST 103A
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City | BAKERSFIELD
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State | CA
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Zip | 93301-5734
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Country | US
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Telephone | 661-322-3225
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Fax | 661-322-2997
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Authorized Official
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Title or Position | OWNER
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Name | MS. JACQUELYN A. KOTARAC
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Credential | M.D.
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Telephone | 661-322-3225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G75557
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License Number State | CA
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