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General NPI Number Information
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NPI Number | 1376096487
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Entity Type | Individual
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Provider Name | JACQUELINE LEE CHACE COTA
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Gender | Female
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 470 N VILLA CT #206
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City | PALM SPRINGS
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State | CA
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Zip | 92262-0669
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Country | US
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Telephone | 401-368-2588
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Fax |
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Provider Business Mailing Address
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Address Line | 10 FENNER ST
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City | CRANSTON
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State | RI
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Zip | 02910
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Country | US
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Telephone | 401-368-2588
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 3512
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License Number State | CA
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