Healthcare Provider Details

I. General information

NPI: 1477884195
Provider Name (Legal Business Name): JESSICA HERNANDEZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 N RAYMOND AVE SUITE 200
ANAHEIM CA
92801-1120
US

IV. Provider business mailing address

27261 LAS RAMBLAS STE 220
MISSION VIEJO CA
92691-6468
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-8650
  • Fax:
Mailing address:
  • Phone: 714-966-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: