Healthcare Provider Details

I. General information

NPI: 1518872225
Provider Name (Legal Business Name): VICTORIA PACE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 HWY 333
MORIARTY NM
87035
US

IV. Provider business mailing address

14 SALIDA DEL SOL TRL
EDGEWOOD NM
87015-6878
US

V. Phone/Fax

Practice location:
  • Phone: 505-832-4471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOT-2025-0051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: