Healthcare Provider Details

I. General information

NPI: 1548001944
Provider Name (Legal Business Name): KARINNA SIERRA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 E BROADWAY BLVD STE 1500
TUCSON AZ
85711-3787
US

IV. Provider business mailing address

9150 W INDIAN SCHOOL RD STE 130
PHOENIX AZ
85037-2388
US

V. Phone/Fax

Practice location:
  • Phone: 480-787-5387
  • Fax: 866-701-4982
Mailing address:
  • Phone: 480-787-5387
  • Fax: 623-232-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberOTA-046612
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-046612
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: