Healthcare Provider Details

I. General information

NPI: 1265871057
Provider Name (Legal Business Name): DANIEL GONZALEZ COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 FIRESTONE BLVD SUITE 123
DOWNEY CA
90241
US

IV. Provider business mailing address

6100 HEREFORD DR
LOS ANGELES CA
90022-5311
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-5820
  • Fax:
Mailing address:
  • Phone: 323-470-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 2585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: