MEDICARE: MISS MARIA E MEDRANO COTA/L

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
1	224Z00000X	Occupational Therapy Assistant	4221	CA

General Provider Information

NPI Number	:	1699401380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA E MEDRANO COTA/L

Provider Business Mailing Address
First Line	:	9828 GARDEN GROVE BLVD STE 110
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1655
Country	:	US
Telephone Number	:	213-905-0449
Fax Number	:

Provider Business Practice Location Address
First Line	:	9828 GARDEN GROVE BLVD STE 110
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1655
Country	:	US
Telephone Number	:	213-905-0449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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