=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417556440
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COTTAGE CLINICAL NETWORK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2020
-----------------------------------------------------
Last Update Date | 10/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7070 HOLLISTER AVE STE 103
-----------------------------------------------------
City | GOLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93117-2895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 180-532-4927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 689
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93102-0689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | BRETT TANDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-569-7548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------