Healthcare Provider Details

I. General information

NPI: 1225537384
Provider Name (Legal Business Name): DANIELLE SANDOVAL B.S., COTA (AA)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE TAPIA COTA

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE UNIT 27
ALHAMBRA CA
91803
US

IV. Provider business mailing address

1000 S FREMONT AVE UNIT 27
ALHAMBRA CA
91803-8849
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-7472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: