Healthcare Provider Details

I. General information

NPI: 1184310062
Provider Name (Legal Business Name): RICHARD THEODORE CICH COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 DIAMOND ST
ANDERSON CA
96007-2930
US

IV. Provider business mailing address

1730 DIAMOND ST
ANDERSON CA
96007-2930
US

V. Phone/Fax

Practice location:
  • Phone: 530-722-7140
  • Fax:
Mailing address:
  • Phone: 530-215-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: