Healthcare Provider Details

I. General information

NPI: 1760316111
Provider Name (Legal Business Name): ERICA WALDOR COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 NEW YORK AVE APT 1802
FAIR OAKS CA
95628-7343
US

IV. Provider business mailing address

4050 NEW YORK AVE APT 1802
FAIR OAKS CA
95628-7343
US

V. Phone/Fax

Practice location:
  • Phone: 916-807-9757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: