Healthcare Provider Details

I. General information

NPI: 1861879215
Provider Name (Legal Business Name): OLGA COTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 GENEVA ST
LOS ANGELES CA
90020-1117
US

IV. Provider business mailing address

716 W GRAVES AVE
MONTEREY PARK CA
91754-3829
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-3151
  • Fax:
Mailing address:
  • Phone: 323-767-7917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number769298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: