Provider Demographics
NPI:1679649115
Name:COTTONWOOD MEDICAL, INC
Entity Type:Organization
Organization Name:COTTONWOOD MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STERLING
Authorized Official - Last Name:SERGENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:818-422-2965
Mailing Address - Street 1:4215 W TOLUCA LAKE LN
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4034
Mailing Address - Country:US
Mailing Address - Phone:818-422-2965
Mailing Address - Fax:818-736-5030
Practice Address - Street 1:3118 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2313
Practice Address - Country:US
Practice Address - Phone:818-422-2965
Practice Address - Fax:818-736-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies