MEDICARE: DOLORES SANCHEZ COTA APCC

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	101YM0800X	Mental Health Counselor	APCC16765	CA

General Provider Information

NPI Number	:	1255175055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLORES SANCHEZ COTA APCC

Provider Business Mailing Address
First Line	:	PO BOX 878
Second Line	:
City	:	BEAUMONT
State	:	CA
Zip	:	92223-0878
Country	:	US
Telephone Number	:	760-835-1880
Fax Number	:

Provider Business Practice Location Address
First Line	:	77564 COUNTRY CLUB DR STE 201
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0449
Country	:	US
Telephone Number	:	760-835-1880
Fax Number	:

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

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	06/27/2024

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