Healthcare Provider Details

I. General information

NPI: 1255752671
Provider Name (Legal Business Name): SAMANTHA NAVALTA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA GUAN

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date: 03/09/2021
Reactivation Date: 04/07/2021

III. Provider practice location address

8135 PAINTER AVE SUITE 200
WHITTIER CA
90602-3158
US

IV. Provider business mailing address

5730 FAUST AVE
LAKEWOOD CA
90713-1211
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax: 562-698-6613
Mailing address:
  • Phone: 562-881-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number21204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: