Healthcare Provider Details

I. General information

NPI: 1598499378
Provider Name (Legal Business Name): NICHOLAS DAVID DELIA COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N SUNSET AVE STE D
WEST COVINA CA
91790-2278
US

IV. Provider business mailing address

648 VALLEY SPRINGS DR
WALNUT CA
91789-4138
US

V. Phone/Fax

Practice location:
  • Phone: 626-671-6100
  • Fax:
Mailing address:
  • Phone: 909-348-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA6036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: