Healthcare Provider Details

I. General information

NPI: 1306515184
Provider Name (Legal Business Name): JENNA ANN GAY COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 N MAGNOLIA AVE
SANTEE CA
92071-4513
US

IV. Provider business mailing address

9703 CAMBURY DR
SANTEE CA
92071-1517
US

V. Phone/Fax

Practice location:
  • Phone: 619-749-7059
  • Fax:
Mailing address:
  • Phone: 161-986-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number448589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: