Provider Demographics
NPI:1831458959
Name:COTA, BIANCA (PSYD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:COTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 W GRANGEVILLE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2833
Mailing Address - Country:US
Mailing Address - Phone:559-585-1898
Mailing Address - Fax:559-585-1893
Practice Address - Street 1:598 W GRANGEVILLE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2833
Practice Address - Country:US
Practice Address - Phone:559-585-1898
Practice Address - Fax:559-585-1893
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical