Healthcare Provider Details

I. General information

NPI: 1831653443
Provider Name (Legal Business Name): LOUIE ALBERT R LOTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD
RIVERSIDE CA
92503-3678
US

IV. Provider business mailing address

2320 WOODHOLLOW CIR
CORONA CA
92881-8690
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-8320
  • Fax:
Mailing address:
  • Phone: 909-728-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: