Provider Demographics
NPI:1124816251
Name:COTTON, DANNIE L
Entity type:Individual
Prefix:
First Name:DANNIE
Middle Name:L
Last Name:COTTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6139
Mailing Address - Country:US
Mailing Address - Phone:707-655-5472
Mailing Address - Fax:
Practice Address - Street 1:128 EL MONTE AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7947
Practice Address - Country:US
Practice Address - Phone:707-655-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4567736-000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility