1275707457 NPI number — MISS WENDY LYNNE BRANDT COTA

Table of content: MISS WENDY LYNNE BRANDT COTA (NPI 1275707457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275707457 NPI number — MISS WENDY LYNNE BRANDT COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANDT
Provider First Name:
WENDY
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275707457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17250 KNOLL TRAIL DR APT 2002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75248-1162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-850-9321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3498 GREEN VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESCUE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95672-9625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-391-8670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  18-00354 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 14618 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)