Provider Demographics
NPI:1588844385
Name:JILL S COTTELL M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JILL S COTTELL M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-312-1672
Mailing Address - Street 1:15644 POMERADO RD
Mailing Address - Street 2:STE 400
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2400
Mailing Address - Country:US
Mailing Address - Phone:858-312-1672
Mailing Address - Fax:858-912-6421
Practice Address - Street 1:15644 POMERADO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2400
Practice Address - Country:US
Practice Address - Phone:858-312-1672
Practice Address - Fax:858-912-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65247261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19119Medicare PIN
CAG90536Medicare UPIN