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NPI Code Detail

MEDICARE: JORGE RAMOS MEDINA COTA

MEDICARE: JORGE RAMOS MEDINA COTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOC60786993WA

General Provider Information

NPI Number : 1518485804
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE RAMOS MEDINA COTA
Provider Business Mailing Address
First Line : 4749 WAXWING CT NE
Second Line :
City : LACEY
State : WA
Zip : 98516-4534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2320 BORST AVE
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-1410
Country : US
Telephone Number : 360-827-6383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2017
Last Update Date : 09/07/2017

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Directions to “ JORGE RAMOS MEDINA COTA” Practice Location

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