Healthcare Provider Details

I. General information

NPI: 1083202097
Provider Name (Legal Business Name): ZAIDA LIZETH ROMERO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3557 CAMPUS DR
THOUSAND OAKS CA
91360-2744
US

IV. Provider business mailing address

9945 LURLINE AVE APT 201
CHATSWORTH CA
91311-4662
US

V. Phone/Fax

Practice location:
  • Phone: 714-882-9038
  • Fax:
Mailing address:
  • Phone: 661-932-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: