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General NPI Number Information
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NPI Number | 1215725460
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Entity Type | Individual
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Provider Name | MIGUEL SERMONIA DUMLAO JR. COTA/L
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Gender | Male
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 8161 W 3RD STREET
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City | LOS ANGELES
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State | CA
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Zip | 90048
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Country | US
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Telephone | 323-655-2023
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Fax |
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Provider Business Mailing Address
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Address Line | 401 S LAFAYETTE PARK PLACE APARTMENT 207
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City | LOS ANGELES
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State | CA
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Zip | 90057
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Country | US
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Telephone | 213-841-4365
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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 | 7072
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License Number State | CA
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