Healthcare Provider Details

I. General information

NPI: 1841123569
Provider Name (Legal Business Name): BLANCA LUCERO VARGAS MARTINEZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 SANTIAGO ST
SAN FRANCISCO CA
94116-1526
US

IV. Provider business mailing address

82 SIMPSON DR
DALY CITY CA
94015-2714
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-2222
  • Fax:
Mailing address:
  • Phone: 831-540-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: