Healthcare Provider Details

I. General information

NPI: 1700729324
Provider Name (Legal Business Name): MICHAEL MADLEM COTA, LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19957 MODOC RD
APPLE VALLEY CA
92308-6134
US

IV. Provider business mailing address

19957 MODOC RD
APPLE VALLEY CA
92308-6134
US

V. Phone/Fax

Practice location:
  • Phone: 714-308-5548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: