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General NPI Number Information
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NPI Number | 1083407472
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Entity Type | Individual
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Provider Name | ANISH R VYAS COTA/L
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Gender | Male
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 2500 COUNTRY DR
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City | FREMONT
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State | CA
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Zip | 94536-5356
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Country | US
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Telephone | 510-792-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 48695 FLAGSTAFF CT
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City | FREMONT
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State | CA
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Zip | 94539-7708
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Country | US
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Telephone | 510-676-2842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 862
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License Number State | CA
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