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General NPI Number Information
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NPI Number | 1861284507
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Entity Type | Individual
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Provider Name | GENE MATTHEW NINOBLA FLORES COTA/L
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 442 E HAMPTON ST
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City | STOCKTON
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State | CA
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Zip | 95204-5519
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Country | US
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Telephone | 209-466-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 1759 MINI DR
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City | VALLEJO
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State | CA
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Zip | 94589-1517
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Country | US
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Telephone | 707-567-9878
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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 | OTA6934
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License Number State | CA
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