Healthcare Provider Details

I. General information

NPI: 1457213787
Provider Name (Legal Business Name): JOEL MARVIN MALLARI COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7071 WARNER AVE STE A
HUNTINGTON BEACH CA
92647-5444
US

IV. Provider business mailing address

131 LIBERTY ST
TUSTIN CA
92782-6515
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-3800
  • Fax: 714-847-9752
Mailing address:
  • Phone: 714-851-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA1056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: