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General NPI Number Information
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NPI Number | 1518855824
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Entity Type | Individual
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Provider Name | BRIANNE DELA CRUZ ILABAN COTA
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Gender | Female
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 5930 ADOBE RD
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-2356
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Country | US
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Telephone | 702-690-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 5977 ENCELIA DR
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-1935
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Country | US
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Telephone | 702-690-5080
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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 | 7170
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License Number State | CA
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