Provider Demographics
NPI:1861569428
Name:COTTER, RENEE E (MD A PROFESSIONAL CO)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:E
Last Name:COTTER
Suffix:
Gender:F
Credentials:MD A PROFESSIONAL CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 WOODLAKE AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1468
Mailing Address - Country:US
Mailing Address - Phone:818-887-5008
Mailing Address - Fax:818-887-5577
Practice Address - Street 1:7320 WOODLAKE AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1468
Practice Address - Country:US
Practice Address - Phone:818-887-5008
Practice Address - Fax:818-887-5577
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE87054Medicare UPIN
CAW065128Medicare PIN