Provider Demographics
NPI:1558928192
Name:TEVES, AYN RYCCA MOSTRALES (COTA/L)
Entity Type:Individual
Prefix:
First Name:AYN RYCCA
Middle Name:MOSTRALES
Last Name:TEVES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 CRENSHAW BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1965
Mailing Address - Country:US
Mailing Address - Phone:323-549-0100
Mailing Address - Fax:323-549-0103
Practice Address - Street 1:903 CRENSHAW BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1965
Practice Address - Country:US
Practice Address - Phone:323-549-0100
Practice Address - Fax:323-549-0103
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4797224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant