MEDICARE: CITLALLI SALMERON COTA/L

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	224Z00000X	Occupational Therapy Assistant	OTA-2791	NV

General Provider Information

NPI Number	:	1124716972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CITLALLI SALMERON COTA/L

Provider Business Mailing Address
First Line	:	4201 E CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7564
Country	:	US
Telephone Number	:	702-238-3592
Fax Number	:

Provider Business Practice Location Address
First Line	:	7425 W AZURE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4418
Country	:	US
Telephone Number	:	702-515-4009
Fax Number	:

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

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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