Provider Demographics
NPI:1588249460
Name:CHESTNUT, COTY (RCP, RRT)
Entity type:Individual
Prefix:
First Name:COTY
Middle Name:
Last Name:CHESTNUT
Suffix:
Gender:M
Credentials:RCP, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33131 MARINA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1104
Mailing Address - Country:US
Mailing Address - Phone:760-219-6632
Mailing Address - Fax:
Practice Address - Street 1:1045 ATLANTIC AVE STE 616
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3411
Practice Address - Country:US
Practice Address - Phone:760-219-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37747227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered