Healthcare Provider Details

I. General information

NPI: 1659792893
Provider Name (Legal Business Name): DEBRA MIJARES COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 GOLDEN SHR SUITE 250
LONG BEACH CA
90802-4246
US

IV. Provider business mailing address

890 GOVERNOR ST
COSTA MESA CA
92627-3342
US

V. Phone/Fax

Practice location:
  • Phone: 866-414-0448
  • Fax:
Mailing address:
  • Phone: 949-645-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: