Healthcare Provider Details

I. General information

NPI: 1700700390
Provider Name (Legal Business Name): CIERRA JOHNSON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N BERGIN LN
BLOOMFIELD NM
87413-6729
US

IV. Provider business mailing address

205 W CEDAR AVE
BLOOMFIELD NM
87413-5941
US

V. Phone/Fax

Practice location:
  • Phone: 505-632-4314
  • Fax:
Mailing address:
  • Phone: 505-632-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-2026-0098
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: