Healthcare Provider Details

I. General information

NPI: 1730711334
Provider Name (Legal Business Name): ANGELA SOONG COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 4TH ST
SANTA MONICA CA
90401-3319
US

IV. Provider business mailing address

4136 EAST BLVD
LOS ANGELES CA
90066-4610
US

V. Phone/Fax

Practice location:
  • Phone: 310-450-8338
  • Fax:
Mailing address:
  • Phone: 714-330-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number431563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: