MEDICARE: TRINA URTIS 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	1778	CA

General Provider Information

NPI Number	:	1720654965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINA URTIS COTA

Provider Business Mailing Address
First Line	:	4916 VERDURA AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-3018
Country	:	US
Telephone Number	:	562-972-5750
Fax Number	:

Provider Business Practice Location Address
First Line	:	4916 VERDURA AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-3018
Country	:	US
Telephone Number	:	562-972-5750
Fax Number	:

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	05/28/2021

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