Basic Information
| Provider Information | |||||||||
| NPI: | 1972720688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COTTMAN | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 EMELINE AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950601976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314544170 | ||||||||
| FaxNumber: | 8314544663 | ||||||||
| Practice Location | |||||||||
| Address1: | 1080 EMELINE AVE | ||||||||
| Address2: | 1400 EMELINE AVE, BLDG K | ||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950601966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314544170 | ||||||||
| FaxNumber: | 8314544663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 03/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A42796 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | ZZZ92069Z | 01 | CA | MEDICARE GROUP ID# | OTHER | ZZZ91891Z | 01 | CA | MEDICARE GROUP ID# | OTHER | ZZZ91892Z | 01 | CA | MEDICARE GROUP ID# | OTHER | A42796 | 01 | CA | MEDICAL LICENSE # | OTHER | BC0509882 | 01 | CA | DEA # | OTHER | ZZZ92073Z | 01 | CA | MEDICARE GROUP ID# | OTHER |