Provider Demographics
NPI:1073287298
Name:COTA, MARCOS E (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:E
Last Name:COTA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4113
Mailing Address - Country:US
Mailing Address - Phone:775-329-6300
Mailing Address - Fax:775-870-4686
Practice Address - Street 1:3915 NEIL RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6808
Practice Address - Country:US
Practice Address - Phone:775-329-6300
Practice Address - Fax:775-870-4686
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NVPA2791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250024086Medicaid
NVV78076OtherPTAN