Healthcare Provider Details

I. General information

NPI: 1831233725
Provider Name (Legal Business Name): YOLANDA CHAUCA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W 34TH ST FL 15
NEW YORK NY
10001-2406
US

IV. Provider business mailing address

330 W 34TH ST FL 15
NEW YORK NY
10001-2406
US

V. Phone/Fax

Practice location:
  • Phone: 212-947-5770
  • Fax: 212-594-4538
Mailing address:
  • Phone: 212-947-5770
  • Fax: 212-594-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number003790-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: