Basic Information
Provider Information
NPI: 1003014523
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COTWRIGHT
FirstName: ANTONIA
MiddleName: LEIGH
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 510 N PROSPECT AVE. SUITE 320
Address2:  
City: REDONDO BEACH
State: CA
PostalCode: 902773032
CountryCode: US
TelephoneNumber: 3103762716
FaxNumber: 3103749163
Practice Location
Address1: 510 N PROSPECT AVE SUITE 320
Address2:  
City: REDONDO BEACH
State: CA
PostalCode: 902773032
CountryCode: US
TelephoneNumber: 3103762716
FaxNumber: 3103749163
Other Information
ProviderEnumerationDate: 07/05/2007
LastUpdateDate: 07/10/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X036-118703ILY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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