Healthcare Provider Details

I. General information

NPI: 1033033626
Provider Name (Legal Business Name): TRACY HUME COTA/L, CSRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 PEDLEY RD
JURUPA VALLEY CA
92509-3966
US

IV. Provider business mailing address

PO BOX 204
RED BOILING SPRINGS TN
37150-0204
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-4100
  • Fax:
Mailing address:
  • Phone: 615-388-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: