Healthcare Provider Details

I. General information

NPI: 1063348431
Provider Name (Legal Business Name): EVELYN JESSICA QUINTANA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 ARTESIA BLVD STE 107
REDONDO BEACH CA
90278-3412
US

IV. Provider business mailing address

25627 WESTERN AVE APT 3
LOMITA CA
90717-2738
US

V. Phone/Fax

Practice location:
  • Phone: 424-275-9968
  • Fax:
Mailing address:
  • Phone: 310-944-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: