Healthcare Provider Details

I. General information

NPI: 1609264282
Provider Name (Legal Business Name): PATRICK JAGGARD COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 ALTA ARDEN EXPY
SACRAMENTO CA
95825-2103
US

IV. Provider business mailing address

2409 G ST
SACRAMENTO CA
95816-3607
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-5500
  • Fax: 916-481-9845
Mailing address:
  • Phone: 916-942-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTA1680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: