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NPI Code Detail

MEDICARE: SUSANA GONZALEZ COTAL

MEDICARE: SUSANA GONZALEZ COTAL
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
1224Z00000XOccupational Therapy Assistant1298CA

General Provider Information

NPI Number : 1639296841
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANA GONZALEZ COTAL
Provider Business Mailing Address
First Line : 1451 YOSEMITE DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90041-2808
Country : US
Telephone Number : 323-257-8763
Fax Number :
Provider Business Practice Location Address
First Line : 4655 RUFFNER ST STE 270
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-2276
Country : US
Telephone Number : 800-787-6787
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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Directions to “ SUSANA GONZALEZ COTAL” Practice Location

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