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General NPI Number Information
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NPI Number | 1609227719
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Entity Type | Individual
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Provider Name | ALTHEA VALENCERINA COTA/L
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Gender | Female
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 255 E BONITA AVE
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City | POMONA
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State | CA
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Zip | 91767-1923
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Country | US
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Telephone | 909-596-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 9472 HEARTHSIDE CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5757
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Country | US
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Telephone | 951-897-4415
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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 | 2857
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License Number State | CA
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