Provider Demographics
NPI:1114985892
Name:COTE, MARY ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNETTE
Last Name:COTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ANNETTE
Other - Last Name:COTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17742 BEACH BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6818
Mailing Address - Country:US
Mailing Address - Phone:714-596-4488
Mailing Address - Fax:714-596-5522
Practice Address - Street 1:17742 BEACH BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6818
Practice Address - Country:US
Practice Address - Phone:714-596-4488
Practice Address - Fax:714-596-5522
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45008207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEO2656Medicare UPIN
CAPTAN G45008BMedicare PIN