Healthcare Provider Details

I. General information

NPI: 1720944341
Provider Name (Legal Business Name): MARISSA JUILIANA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15933 SEQUOIA ST
HESPERIA CA
92345-1729
US

IV. Provider business mailing address

15933 SEQUOIA ST
HESPERIA CA
92345-1729
US

V. Phone/Fax

Practice location:
  • Phone: 760-906-0581
  • Fax:
Mailing address:
  • Phone: 760-906-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: