Healthcare Provider Details

I. General information

NPI: 1922991280
Provider Name (Legal Business Name): ALISSA CRAMER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 SAN JACINTO RD
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

2016 SAN JACINTO RD
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-4192
  • Fax:
Mailing address:
  • Phone: 760-719-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number8105
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: