Individual
MRS. SUSSANN GRACE KOTARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3501 MILLS AVE, AUSTIN, TX 78731-6309
(210) 865-7776
Mailing address
3501 MILLS AVE, AUSTIN, TX 78731-6309
(210) 865-7776
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
BP1-0035463
TX
Other
Enumeration date
05/27/2009
Last updated
05/27/2009
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