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General NPI Number Information
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NPI Number | 1396548822
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Entity Type | Individual
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Provider Name | DANIEL JOSEPH VERGARA LAFRADEZ COTA/L
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Gender | Male
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 198 CIRBY WAY STE 140
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City | ROSEVILLE
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State | CA
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Zip | 95678-6430
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Country | US
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Telephone | 916-773-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 10096 MOSAIC WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-5959
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Country | US
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Telephone | 916-340-5663
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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 | 523733
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License Number State | CA
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