1285763243 NPI number — LAURA ANN PERKINS COTA

Table of content: LAURA ANN PERKINS COTA (NPI 1285763243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285763243 NPI number — LAURA ANN PERKINS COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
LAURA ANN
Provider Middle Name:
Provider Name Prefix Text:
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:
1285763243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 E RIVIERA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78613-4638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-921-0317
Provider Business Mailing Address Fax Number:
610-438-2046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 SUNRISE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78664-9323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-991-2034
Provider Business Practice Location Address Fax Number:
610-438-2046
Provider Enumeration Date:
03/05/2007

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 208545 . This is a "ECPTOTE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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