Healthcare Provider Details

I. General information

NPI: 1427592633
Provider Name (Legal Business Name): ROSA CROCE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W COVINA BLVD STE 220
SAN DIMAS CA
91773-3205
US

IV. Provider business mailing address

518 E TUDOR ST
COVINA CA
91722-2108
US

V. Phone/Fax

Practice location:
  • Phone: 909-675-7017
  • Fax:
Mailing address:
  • Phone: 626-433-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number3699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: