Provider Demographics
NPI:1992827950
Name:KOTECHA, MONA K (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:K
Last Name:KOTECHA
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 1:333 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1147
Mailing Address - Country:US
Mailing Address - Phone:650-522-4065
Mailing Address - Fax:
Practice Address - Street 1:333 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1147
Practice Address - Country:US
Practice Address - Phone:650-522-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95000207L00000X
NH15539207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAX170RMedicare PIN