Healthcare Provider Details

I. General information

NPI: 1477269355
Provider Name (Legal Business Name): ANASTAZIA GROSS COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANASTASIA PHILLIPS

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2761 RICHMOND HWY STE 105
STAFFORD VA
22554-8330
US

IV. Provider business mailing address

21600 OXNARD ST
WOODLAND HILLS CA
91367-4976
US

V. Phone/Fax

Practice location:
  • Phone: 540-699-3877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131002817
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: