Provider Demographics
NPI:1972679413
Name:COTTER, EVA-RENATE CHRISTINE (L AC)
Entity Type:Individual
Prefix:
First Name:EVA-RENATE
Middle Name:CHRISTINE
Last Name:COTTER
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16730 WIKIUP RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4189
Mailing Address - Country:US
Mailing Address - Phone:619-667-9931
Mailing Address - Fax:619-562-9871
Practice Address - Street 1:8954 CARLTON HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2932
Practice Address - Country:US
Practice Address - Phone:619-667-9931
Practice Address - Fax:619-562-9871
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist