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General NPI Number Information
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NPI Number | 1942185954
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Entity Type | Individual
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Provider Name | IRMA OLIVARES COTA
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Gender | Female
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 301 E VANDERBILT WAY STE 100
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3556
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Country | US
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Telephone | 95-672-6619
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Fax |
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Provider Business Mailing Address
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Address Line | 4959 PALO VERDE ST STE 109C
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City | MONTCLAIR
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State | CA
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Zip | 91763-2358
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Country | US
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Telephone | 909-971-3092
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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 | 7215
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License Number State | CA
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