Individual provider Active NPI

Christopher Douglas Kotz, IDC

  • Independent Duty Corpsman
  • San Diego, CA
National Provider Identifier
1093912149
Registry record updated Jan 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Independent Duty CorpsmanTaxonomy code 1710I1002X
Practice address
3325 Senn Rd
Building 55, Room 225
San Diego, CA 92136-5029
Phone
(619) 556-5454
NPI assigned
Jul 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Duty Corpsman 1710I1002X CA Primary

Addresses

Primary practice location

3325 Senn Rd
Building 55, Room 225
San Diego, CA 92136-5029

Mailing address

13044 Yerba Valley Way
Lakeside, CA 92040-1579
Phone (817) 881-8696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199750400000",
    "number": "1093912149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13044 YERBA VALLEY WAY",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920401579",
            "telephone_number": "817-881-8696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 SENN RD",
            "address_2": "BUILDING 55, ROOM 225",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921365029",
            "telephone_number": "619-556-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTZ",
        "first_name": "CHRISTOPHER",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2008-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.