=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457213787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL MARVIN MALLARI COTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2025
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7071 WARNER AVE STE A
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-5444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-847-3800
-----------------------------------------------------
Fax | 714-847-9752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 LIBERTY ST
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92782-6515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-851-3334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OTA1056
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------