Jacqueline Elise Cootes
Individual provider Active NPI General Practice Dentistry · San Pedro, CA
NPI 1578283321 · NPPES record last updated May 1, 2023
Key facts
- NPI
- 1578283321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 107943 (CA)
- Practice address
- 732 W 9TH St Ste 204
San Pedro, CA 90731-3629 - Phone
- (310) 833-1386
- NPI assigned
- Aug 31, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107943 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Jacqueline Cootes, DDS Inc. | General Practice | Current |
Accepting new patients |
| Michael M Nishida DDS Inc | Past |
Accepting new patients |
Locations
732 W 9th St
Ste 204
San Pedro, CA 90731
Phone (310) 833-1386
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 107943 | CA | Yes |
Addresses
Primary practice location
732 W 9TH St Ste 204
San Pedro, CA 90731-3629
Mailing address
42 Eastfield Dr
Rolling Hills, CA 90274-5262
Phone (310) 293-9985
Other providers in San Pedro, CA
- Connect With Care, LLC
- Consumerhealth, Inc.
- Consumerhealth, Inc.
- Mary Susan Cook
- Danielle Cooper
- Candace Coppinger
- Redentor Prijoles Cornejo
- Anabel Corona Lara
- Francisco J Correa
- Alexis Cortez
All providers in San Pedro, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.