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General NPI Number Information
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NPI Number | 1669007738
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Entity Type | Individual
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Provider Name | SARA RENAE MARTINEZ COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 1461 MERRITT DR
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City | EL CAJON
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State | CA
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Zip | 92020-7862
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Country | US
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Telephone | 858-945-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 9908 KIKA CT APT 822
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City | SAN DIEGO
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State | CA
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Zip | 92129-5008
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Country | US
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Telephone | 602-499-8548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4987
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License Number State | CA
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