Provider Demographics
NPI:1578689535
Name:ZACHARIAH, VALSALA THOLATH (COTA, RN)
Entity Type:Individual
Prefix:
First Name:VALSALA
Middle Name:THOLATH
Last Name:ZACHARIAH
Suffix:
Gender:F
Credentials:COTA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O CBOT, 444 NORTH THIRD ST.
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2011
Practice Address - Country:US
Practice Address - Phone:800-870-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA804699163W00000X
CA1457224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No163W00000XNursing Service ProvidersRegistered Nurse