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General NPI Number Information
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NPI Number | 1104623875
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Entity Type | Individual
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Provider Name | SUSAN RAMIREZ TAYLOR COTA
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Gender | Female
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 943 N GRAND AVE
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City | COVINA
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State | CA
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Zip | 91724-2046
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Country | US
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Telephone | 626-671-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 18342 E WOODCROFT ST
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City | AZUSA
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State | CA
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Zip | 91702-5842
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Country | US
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Telephone | 626-621-7397
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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 | 7078
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License Number State | CA
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