Healthcare Provider Details

I. General information

NPI: 1487438248
Provider Name (Legal Business Name): ANGELICA ANABELLA DEL RAZO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 I ST NE
AUBURN WA
98002-2410
US

IV. Provider business mailing address

112 ASPEN LN S
PACIFIC WA
98047-1259
US

V. Phone/Fax

Practice location:
  • Phone: 253-561-8100
  • Fax:
Mailing address:
  • Phone: 253-486-7790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOC61381301
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: