Healthcare Provider Details

I. General information

NPI: 1467017863
Provider Name (Legal Business Name): JOSHUA GUNNER HUTCHISON COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34400 MISSION BLVD
UNION CITY CA
94587-3604
US

IV. Provider business mailing address

4105 32ND ST
SACRAMENTO CA
95820-2633
US

V. Phone/Fax

Practice location:
  • Phone: 510-471-3434
  • Fax:
Mailing address:
  • Phone: 209-712-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: