1316296122 NPI number — MR. RITHIRAT JOHN MCCOLLUM COTA

Table of content: MR. RITHIRAT JOHN MCCOLLUM COTA (NPI 1316296122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316296122 NPI number — MR. RITHIRAT JOHN MCCOLLUM COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOLLUM
Provider First Name:
RITHIRAT
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCOLLUM
Provider Other First Name:
RITHIRAT
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316296122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16236 W. TONTO ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODYEAR
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-829-7118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 WEST BROWN RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-833-3988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2012

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: 314000000X , with the licence number:  3539 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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