Healthcare Provider Details

I. General information

NPI: 1487307591
Provider Name (Legal Business Name): SERGIO VIGIL COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 E EARLY AVE
REEDLEY CA
93654-3274
US

IV. Provider business mailing address

2423 E EARLY AVE
REEDLEY CA
93654-3274
US

V. Phone/Fax

Practice location:
  • Phone: 909-528-9926
  • Fax:
Mailing address:
  • Phone: 909-528-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: