MEDICARE: TINA YIP COTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	224Z00000X	Occupational Therapy Assistant	4772	CA

General Provider Information

NPI Number	:	1093175937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA YIP COTA

Provider Business Mailing Address
First Line	:	514 SEFTON AVE APT A
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-3439
Country	:	US
Telephone Number	:	626-226-8827
Fax Number	:

Provider Business Practice Location Address
First Line	:	774 S PLACENTIA AVE STE 200
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-6838
Country	:	US
Telephone Number	:	800-870-7989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	03/24/2019

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