MS. CRYSTAL LISA RENE DE COTRET (NPI# 1780982819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780982819 |
| Entity Type | Individual |
| Full Name | MS. CRYSTAL LISA RENE DE COTRET |
| Credential | MPAP, PA-C |
| Practice Address |
1019 S Central Ave Glendale CA 91204-2210 |
| Practice Telephone | 8182444374 |
| Practice Fax Number | 8182440633 |
| Mailing Telephone | 8182444374 |
| Mailing Fax Number | 8182440633 |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2015-07-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA21595 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1019 S CENTRAL AVE |
| City | GLENDALE |
| State | CA |
| Zip Code | 91204-2210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750383766 | Andrew S Hurwitz | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1019 S Central Ave, Suite 530, Glendale, CA 91204-2210 | 2005-08-10 |
| 1659752699 | Chase Hungerford | Physician Assistant | 1019 S Central Ave, Glendale, CA 91204-2210 | 2015-06-16 |
| 1780820217 | Hurwitz-roberts A Medical Corporation | Surgery | 1019 S Central Ave, Glendale, CA 91204-2210 | 2009-01-06 |
| 1114929809 | Randall F Roberts | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1019 S Central Ave, Glendale, CA 91204-2210 | 2005-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558997387 | Hope & Trust Trading LLC | Radiology | 318 W Colorado St #2, Glendale, CA 91204 | 2020-03-12 |
| 1972133387 | Yusuf Toliver | Counselor | 1027 S Central Ave, Suite 200, Glendale, CA 91204 | 2020-01-24 |
| 1538633136 | Pathology La Inc. | Clinical Medical Laboratory | 4634 San Fernando Rd., Same As Above, Glendale, CA 91204 | 2019-01-16 |
| 1295254050 | Glendale Back and Pain Center | Neurological Surgery | 710 S. Central Ave, Suite 240, Glendale, CA 91204 | 2017-09-13 |
| 1285163568 | Ez Trans, Inc. | Transportation Broker | 1626 S. Central Ave., Glendale, CA 91204 | 2017-06-08 |
| 1194254474 | Jenny Chung | Pharmacist | 3943 San Fernando Road, Glendale, CA 91204 | 2017-06-08 |
| 1396111886 | Fresenius Medical Care Glendale, LLC | Clinic/Center | 623 S Central Ave, Glendale, CA 91204 | 2015-08-19 |
| 1710302450 | New Age Foot and Ankle Podiatry PC | Podiatrist | 705 Ivy Street, Glendale, CA 91204 | 2014-03-04 |
| 1124454376 | Alber K. Karamanoukian Medical Clinic, Inc. | Clinic/Center | 810 S. Central Avenue, Suite 100, Glendale, CA 91204 | 2013-09-19 |
| 1548521156 | Glendale Plastic and Reconstructive Surgery Inc. | Plastic Surgery | 1500 S. Central Ave. #126, Glendale, CA 91204 | 2012-05-31 |
| Find all providers in zip 91204 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356833578 | Michael James Gonzalez | Physician Assistant | 1500 E Chevy Chase Dr # 401a401b, Glendale, CA 91206-4152 | 2018-06-04 |
| 1871962043 | Molly Ann Bailey | Physician Assistant | 6234 W Behrend Dr, Apt 3109, Glendale, AZ 85308-6905 | 2015-09-17 |
| 1538316799 | Nara Sargsian | Physician Assistant | 800 S Central Ave Ste 308, Glendale, CA 91204-4644 | 2008-08-19 |
| 1861502643 | Blake Marcus Hess | Physician Assistant | 12801 N 65th Ave, Glendale, AZ 85304-1648 | 2006-08-30 |
| 1780675314 | Martha K Heer | Physician Assistant | 1501 W Frier Dr, Glendale, AZ 85312-5343 | 2005-11-02 |
| 1659865525 | Jennifer Mcgovern | Physician Assistant | 1560 E Chevy Chase Dr Ste 430, Glendale, CA 91206-4140 | 2018-06-14 |
| 1265848105 | Arizona Surgical Assistants, LLC | Physician Assistant | 5555 W Thunderbird Rd, Glendale, AZ 85306-4622 | 2014-07-10 |
| 1568605236 | Michael Nadzhafov | Physician Assistant | 1141 N Brand Blvd, Ste. 300, Glendale, CA 91202-2511 | 2009-04-10 |
| 1477716363 | Leah Chu Lovely | Physician Assistant | 1812 Verdugo Blvd, Glendale, CA 91208-1407 | 2008-07-09 |
| 1902092992 | Ezekias John Zink | Physician Assistant | 4344 W Bell Rd, Suite 102, Glendale, AZ 85308-3589 | 2007-09-24 |
| Find all providers in GLENDALE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.