Healthcare Provider Details

I. General information

NPI: 1609253723
Provider Name (Legal Business Name): RACHEL LYNNE CAYOT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL LYNNE CAYOT COTA

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CRYSTAL SPRINGS RD APT 1816
SAN BRUNO CA
94066-4646
US

IV. Provider business mailing address

2000 CRYSTAL SPRINGS RD APT 1816
SAN BRUNO CA
94066-4646
US

V. Phone/Fax

Practice location:
  • Phone: 260-402-7527
  • Fax:
Mailing address:
  • Phone: 260-402-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberOTA 1794
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 1794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: