Healthcare Provider Details

I. General information

NPI: 1962921908
Provider Name (Legal Business Name): NICOLE J COTA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ZINTAK RDN

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/21/2022
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5452
US

IV. Provider business mailing address

14045 N 7TH ST STE 4
PHOENIX AZ
85022-4387
US

V. Phone/Fax

Practice location:
  • Phone: 480-301-8000
  • Fax:
Mailing address:
  • Phone: 623-399-6825
  • Fax: 623-505-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86099924
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number326308
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: