Provider Demographics
NPI:1346413143
Name:CLOSE, CATHERINE COTTERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:COTTERMAN
Last Name:CLOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27107 TOURNEY RD
Mailing Address - Street 2:DEPARTMENT OF DERMATOLOGY
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1860
Mailing Address - Country:US
Mailing Address - Phone:888-788-5000
Mailing Address - Fax:
Practice Address - Street 1:27107 TOURNEY RD
Practice Address - Street 2:DEPARTMENT OF DERMATOLOGY
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1860
Practice Address - Country:US
Practice Address - Phone:888-788-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2973207N00000X
LAMD.201794207N00000X
CAA120320207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1079707Medicaid
MS08172871Medicaid
LA4P0437061Medicare PIN
LA4P043Medicare PIN