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General NPI Number Information
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NPI Number | 1619337185
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Entity Type | Individual
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Provider Name | JULIA KARIBIAN COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 2983 STRAUSS COURT
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City | WOODSTOCK
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State | IL
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Zip | 60098
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Country | US
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Telephone | 618-402-0960
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Fax |
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Provider Business Mailing Address
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Address Line | 2983 STRAUSS CT
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City | WOODSTOCK
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State | IL
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Zip | 60098-8076
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Country | US
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Telephone | 618-402-0960
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 057.002429
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License Number State | IL
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