Healthcare Provider Details

I. General information

NPI: 1437061058
Provider Name (Legal Business Name): RYAN THEOBALD COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3977 BEVERLY BLVD APT 118
LOS ANGELES CA
90004-3999
US

IV. Provider business mailing address

3977 BEVERLY BLVD APT 118
LOS ANGELES CA
90004-3999
US

V. Phone/Fax

Practice location:
  • Phone: 440-591-3954
  • Fax:
Mailing address:
  • Phone: 440-591-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: