Healthcare Provider Details

I. General information

NPI: 1831762566
Provider Name (Legal Business Name): CHLOE COTO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE # 107
COLTON CA
92324-1819
US

IV. Provider business mailing address

400 N PEPPER AVE
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-2178
  • Fax: 909-580-1388
Mailing address:
  • Phone: 909-580-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: