MEDICARE: ALFONSO ORTIZ 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	3347	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0012833887	OTHER	CA	KAISER

General Provider Information

NPI Number	:	1861864183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFONSO ORTIZ COTA/L

Provider Business Mailing Address
First Line	:	9014 HASKELL AVE
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-3112
Country	:	US
Telephone Number	:	818-987-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	9014 HASKELL AVE
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-3112
Country	:	US
Telephone Number	:	818-987-2010
Fax Number	:

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

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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Directions to “ ALFONSO ORTIZ COTA/L” Practice Location

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