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General NPI Number Information
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NPI Number | 1891464608
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Entity Type | Individual
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Provider Name | JONATHAN M AUSTRIA COTA/L
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Gender | Male
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 1300 N VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-6098
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Country | US
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Telephone | 213-413-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 18238 LAGUNA PL
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City | FONTANA
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State | CA
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Zip | 92336-3059
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Country | US
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Telephone | 909-201-4128
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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 | 5441
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License Number State | CA
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