Provider Demographics
NPI:1548275969
Name:COTA, LAUREEN (DPM)
Entity type:Individual
Prefix:
First Name:LAUREEN
Middle Name:
Last Name:COTA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 N 19TH AVE
Mailing Address - Street 2:#103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1104
Mailing Address - Country:US
Mailing Address - Phone:602-274-4100
Mailing Address - Fax:602-246-1565
Practice Address - Street 1:6707 N 19TH AVE
Practice Address - Street 2:#103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1104
Practice Address - Country:US
Practice Address - Phone:602-274-4100
Practice Address - Fax:602-246-1565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0644213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery