Healthcare Provider Details

I. General information

NPI: 1518357417
Provider Name (Legal Business Name): VANESSA DYOCO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA CANTORIA COTA

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5878 BACKUS PEAK WAY
FONTANA CA
92336-4584
US

IV. Provider business mailing address

5878 BACKUS PEAK WAY
FONTANA CA
92336-4584
US

V. Phone/Fax

Practice location:
  • Phone: 909-587-3331
  • Fax: 888-865-7680
Mailing address:
  • Phone: 909-587-3331
  • Fax: 888-865-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: