Provider Demographics
NPI:1124110572
Name:WILLIAM COTTLES, JR., M.D.,INC.
Entity type:Organization
Organization Name:WILLIAM COTTLES, JR., M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:(NONE)
Authorized Official - Last Name:COTTLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:323-295-6521
Mailing Address - Street 1:3756 SANTA ROSALIA DR.
Mailing Address - Street 2:SUITE 503
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3656
Mailing Address - Country:US
Mailing Address - Phone:323-295-6521
Mailing Address - Fax:323-295-0228
Practice Address - Street 1:3756 SANTA ROSALIA DR.
Practice Address - Street 2:SUITE 503
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3656
Practice Address - Country:US
Practice Address - Phone:323-295-6521
Practice Address - Fax:323-295-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC23419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C234190Medicaid
CAC23419Medicare ID - Type Unspecified
A86878Medicare UPIN