Provider Demographics
NPI:1114375896
Name:COTERA, VICTOR
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:COTERA
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 1:2005 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4123
Mailing Address - Country:US
Mailing Address - Phone:661-336-6765
Mailing Address - Fax:661-336-6765
Practice Address - Street 1:2005 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4123
Practice Address - Country:US
Practice Address - Phone:661-336-6765
Practice Address - Fax:661-336-6765
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3561236OtherDRIVER'S LICENSE