Provider Demographics
NPI:1518357417
Name:DYOCO, VANESSA (COTA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DYOCO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:CANTORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:5878 BACKUS PEAK WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4584
Mailing Address - Country:US
Mailing Address - Phone:909-587-3331
Mailing Address - Fax:888-865-7680
Practice Address - Street 1:5878 BACKUS PEAK WAY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4584
Practice Address - Country:US
Practice Address - Phone:909-587-3331
Practice Address - Fax:888-865-7680
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA922224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant