Healthcare Provider Details

I. General information

NPI: 1053228569
Provider Name (Legal Business Name): RYAN CALPO COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12052 IMPERIAL HWY STE 204
NORWALK CA
90650-3092
US

IV. Provider business mailing address

3059 OREGON AVE
LONG BEACH CA
90806-1313
US

V. Phone/Fax

Practice location:
  • Phone: 310-892-5812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: