Organization
REGENTS OF UNIVERSITY OF CALIFORNIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. RONALD A KOTKIN (CLINICAL PROFESSOR)
(949) 824-6292
Entity
Organization
Contact information
Practice address
19262 JAMBOREE RD, IRVINE, CA 92612-2502
(949) 824-2343
(949) 824-8737
Mailing address
19262 JAMBOREE RD, IRVINE, CA 92612-2502
(949) 824-2343
(949) 824-8737
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY12351
CA
Other
Enumeration date
09/12/2007
Last updated
09/14/2007
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