Provider Demographics
NPI:1932192572
Name:COTLIAR, RONALD W (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:COTLIAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13420 NEWPORT AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3745
Mailing Address - Country:US
Mailing Address - Phone:714-731-0061
Mailing Address - Fax:714-731-0164
Practice Address - Street 1:13420 NEWPORT AVE
Practice Address - Street 2:SUITE G
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3745
Practice Address - Country:US
Practice Address - Phone:714-731-0061
Practice Address - Fax:714-731-0164
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG25069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC010ZMedicare PIN