Provider Demographics
NPI:1043916646
Name:COTA, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:COTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 E CALLE SAN ANGELO
Mailing Address - Street 2:
Mailing Address - City:GUADALUPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2540
Mailing Address - Country:US
Mailing Address - Phone:480-309-5720
Mailing Address - Fax:
Practice Address - Street 1:9201 S AVENIDA DEL YAQUI STE 34
Practice Address - Street 2:
Practice Address - City:GUADALUPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2573
Practice Address - Country:US
Practice Address - Phone:480-309-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician