Provider Demographics
NPI:1295945467
Name:COTRUFO, JOHN HENRY (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:COTRUFO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:39155 LIBERTY ST STE G710
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1525
Mailing Address - Country:US
Mailing Address - Phone:510-795-2434
Mailing Address - Fax:510-793-3972
Practice Address - Street 1:39155 LIBERTY ST STE G710
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1525
Practice Address - Country:US
Practice Address - Phone:510-795-2434
Practice Address - Fax:510-793-3972
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A34702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry