Basic Information
| Provider Information | |||||||||
| NPI: | 1033872486 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COTTAGE CLINICAL NETWORK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931020689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056827111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 536 W CHANNEL ISLANDS BLVD # 563-B | ||||||||
| Address2: | |||||||||
| City: | PORT HUENEME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056827111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2021 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | O'CONNELL | ||||||||
| AuthorizedOfficialFirstName: | TARYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE DIRECTOR, OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8057298013 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.