Provider Demographics
NPI:1003918939
Name:KOTEY, ERASMUS DZANI (PA)
Entity Type:Individual
Prefix:MR
First Name:ERASMUS
Middle Name:DZANI
Last Name:KOTEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 N FIGUEROA ST STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3578
Mailing Address - Country:US
Mailing Address - Phone:323-254-4100
Mailing Address - Fax:323-254-5810
Practice Address - Street 1:6100 N FIGUEROA ST STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-3578
Practice Address - Country:US
Practice Address - Phone:323-254-4100
Practice Address - Fax:323-254-5810
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA11297OtherPHYSICIAN ASSISTANT