Provider Demographics
NPI:1427877414
Name:COTNOIR, THOMAS JOSHUA
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSHUA
Last Name:COTNOIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-1297
Mailing Address - Country:US
Mailing Address - Phone:909-866-5070
Mailing Address - Fax:
Practice Address - Street 1:41945 BIG BEAR BLVD STE 221
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-2030
Practice Address - Country:US
Practice Address - Phone:909-566-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker