Provider Demographics
NPI:1073916326
Name:COTTON, MATHEW
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:COTTON
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 1:2925 NIAGRA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1057
Mailing Address - Country:US
Mailing Address - Phone:209-485-6027
Mailing Address - Fax:
Practice Address - Street 1:2925 NIAGRA ST
Practice Address - Street 2:SUITE 3
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1056
Practice Address - Country:US
Practice Address - Phone:209-669-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program