MEDICARE: TISHA ARZALUZ 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	224Z00000X	Occupational Therapy Assistant	2573	CA

General Provider Information

NPI Number	:	1265871479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TISHA ARZALUZ COTA

Provider Business Mailing Address
First Line	:	3760 CONVOY ST
Second Line	:	SUITE 204
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3742
Country	:	US
Telephone Number	:	858-514-0375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 ESTATES DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-9711
Country	:	US
Telephone Number	:	877-817-3280
Fax Number	:

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	08/18/2013

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