MEDICARE: DR JACQUELYN KOTARAC, M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G75557	CA

General Provider Information

NPI Number	:	1396886172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JACQUELYN KOTARAC, M.D., INC.

Provider Business Mailing Address
First Line	:	3941 SAN DIMAS ST
Second Line	:	103A
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-5734
Country	:	US
Telephone Number	:	661-322-3225
Fax Number	:	661-322-2997

Provider Business Practice Location Address
First Line	:	3941 SAN DIMAS ST
Second Line	:	STE. 103A
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-5734
Country	:	US
Telephone Number	:	661-322-3225
Fax Number	:	661-322-2997

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JACQUELYN A. KOTARAC
Credential	:	M.D.
Telephone Number	:	661-322-3225

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/22/2020

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