Provider Demographics
NPI:1437798956
Name:COTA HERNANDEZ, MARTIN COTA
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:COTA
Last Name:COTA HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16782 VON KARMAN AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2417
Mailing Address - Country:US
Mailing Address - Phone:619-550-6368
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:12604 HIDDENCREEK WAY STE C
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2137
Practice Address - Country:US
Practice Address - Phone:562-760-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-01
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No374700000XNursing Service Related ProvidersTechnician