Healthcare Provider Details

I. General information

NPI: 1093358921
Provider Name (Legal Business Name): CRYSTAL JOY SIERRA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL JOY SIERRA

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

5762 OLVERA AVE
SAN DIEGO CA
92114-5430
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax:
Mailing address:
  • Phone: 619-917-5929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: