Healthcare Provider Details

I. General information

NPI: 1902028525
Provider Name (Legal Business Name): ESTELLA CUEVAS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LANDIS AVE. SUITE 201
CHULA VISTA CA
91910
US

IV. Provider business mailing address

482W SAN YSIDRO BLVD #1487
SAN YSIDRO CA
92173
US

V. Phone/Fax

Practice location:
  • Phone: 619-498-8450
  • Fax: 619-498-8453
Mailing address:
  • Phone: 858-514-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: