Healthcare Provider Details

I. General information

NPI: 1801262852
Provider Name (Legal Business Name): BRIELLE MARIE DAVIS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 AVENIDA DEL ORO SUITE 118
OCEANSIDE CA
92056-5829
US

IV. Provider business mailing address

1949 AVENIDA DEL ORO SUITE 118
OCEANSIDE CA
92056-5829
US

V. Phone/Fax

Practice location:
  • Phone: 760-945-6500
  • Fax:
Mailing address:
  • Phone: 760-945-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: