Provider Demographics
NPI:1740765080
Name:COITO, SARA KATELYN
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KATELYN
Last Name:COITO
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 1:1432 EMIGRANT CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-1364
Mailing Address - Country:US
Mailing Address - Phone:209-531-8606
Mailing Address - Fax:
Practice Address - Street 1:1115 14TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1003
Practice Address - Country:US
Practice Address - Phone:209-572-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-66760106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician