Healthcare Provider Details

I. General information

NPI: 1609793165
Provider Name (Legal Business Name): SOMIN LEE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 GARNET ST
TORRANCE CA
90503-3305
US

IV. Provider business mailing address

1547 261ST ST APT 3
HARBOR CITY CA
90710-3392
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-2431
  • Fax:
Mailing address:
  • Phone: 310-658-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: