Provider Demographics
NPI:1659883429
Name:COTA, JAVIER CAMPA JR (CADC-II, ICADC, AAS)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:CAMPA
Last Name:COTA
Suffix:JR
Gender:M
Credentials:CADC-II, ICADC, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8898 CLAIREMONT MESA BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1127
Mailing Address - Country:US
Mailing Address - Phone:858-715-1211
Mailing Address - Fax:
Practice Address - Street 1:8898 CLAIREMONT MESA BLVD STE H
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1127
Practice Address - Country:US
Practice Address - Phone:858-715-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA050350818101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)