Healthcare Provider Details

I. General information

NPI: 1104623875
Provider Name (Legal Business Name): SUSAN RAMIREZ TAYLOR COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 N GRAND AVE
COVINA CA
91724-2046
US

IV. Provider business mailing address

18342 E WOODCROFT ST
AZUSA CA
91702-5842
US

V. Phone/Fax

Practice location:
  • Phone: 626-671-6100
  • Fax:
Mailing address:
  • Phone: 626-621-7397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: