Healthcare Provider Details

I. General information

NPI: 1275991622
Provider Name (Legal Business Name): FLORIN NICODIM COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2016
Last Update Date: 01/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE 600
ENCINO CA
91436-4604
US

IV. Provider business mailing address

2425 CANADA BLVD APT 204
GLENDALE CA
91208-1966
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-1977
  • Fax: 818-986-4752
Mailing address:
  • Phone: 818-484-8754
  • Fax: 818-484-8754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number398
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: