Individual provider Active NPI

Human Kotobi, M.D.

  • Anesthesiology Physician
  • San Diego, CA
National Provider Identifier
1780730887
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A87501 Issued in CA
Practice address
3626 Ruffin Rd
San Diego, CA 92123-1810
Phone
(858) 495-2012
Fax
(858) 565-0507
NPI assigned
Jan 25, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A87501 CA Primary

Addresses

Primary practice location

3626 Ruffin Rd
San Diego, CA 92123-1810

Mailing address

3626 Ruffin Rd
San Diego, CA 92123-1810
Phone (858) 495-2012

Other identifiers 1

IdentifierTypeStateIssuer
00A875010MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070814000829 CA Practitioner - Anesthesiology 0446213227 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Service Medical GroupGroup PAC ID 1153223219, 236 clinicians

Practice addresses (Care Compare)

3626 Ruffin Rd
San Diego, CA 92123-1810
Phone (619) 565-9666

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A87501CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Service Medical Group Anesthesiology CurrentSince Apr 1, 2022 Accepting new patients
Ventura County Anesthesia Medical Group, Inc. Anesthesiology CurrentSince Jul 1, 2012 Accepting new patients

Locations

3626 Ruffin Rd
San Diego, CA 92123
Phone (619) 565-9666

825 N 10th St
Santa Paula, CA 93060
Phone (805) 933-8600

3116 W March Ln
Ste 200
Stockton, CA 95219
Phone (510) 537-1234

3291 Loma Vista Rd
Ventura, CA 93003
Phone (805) 652-6000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1780730887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3626 RUFFIN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231810",
            "telephone_number": "858-495-2012",
            "fax_number": "805-642-8564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3626 RUFFIN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231810",
            "telephone_number": "858-495-2012",
            "fax_number": "858-565-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTOBI",
        "first_name": "HUMAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A87501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A875010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.