Healthcare Provider Details

I. General information

NPI: 1427903368
Provider Name (Legal Business Name): NICHOLAS PAUL SHORTY COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11441 VENTURA BLVD
STUDIO CITY CA
91604-3143
US

IV. Provider business mailing address

17131 ROSCOE BLVD UNIT 12
NORTHRIDGE CA
91325-5218
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: