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General NPI Number Information
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NPI Number | 1619782398
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Entity Type | Individual
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Provider Name | IRVIN ALEXIS GUZMAN COTA/L
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Gender | Male
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 25652 OLD TRABUCO RD
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City | LAKE FOREST
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State | CA
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Zip | 92630-2776
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Country | US
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Telephone | 949-380-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 21022 LOS ALISOS BLVD APT 1816
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-3262
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Country | US
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Telephone |
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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 | 6255
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License Number State | CA
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