Healthcare Provider Details

I. General information

NPI: 1760143598
Provider Name (Legal Business Name): VALERIE NHI PHAN COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 WOODRUFF AVE STE 211
LONG BEACH CA
90808-2149
US

IV. Provider business mailing address

2017 W CARRIAGE DR
SANTA ANA CA
92704-6112
US

V. Phone/Fax

Practice location:
  • Phone: 424-228-6963
  • Fax:
Mailing address:
  • Phone: 714-717-6457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: