Healthcare Provider Details

I. General information

NPI: 1114561560
Provider Name (Legal Business Name): CAMERON JAMES REES COTA(L)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 ACORNS TO OAK DRIVE
PALA CA
92059
US

IV. Provider business mailing address

3227 LINCOLN AVE APT 6
SAN DIEGO CA
92104-2060
US

V. Phone/Fax

Practice location:
  • Phone: 858-610-7340
  • Fax:
Mailing address:
  • Phone: 858-610-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA7283
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: