Provider Demographics
NPI:1922172857
Name:MOTA, MARIO G (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:G
Last Name:MOTA
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 COLORADO AVE
Mailing Address - Street 2:STE 260
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2706
Mailing Address - Country:US
Mailing Address - Phone:209-216-3360
Mailing Address - Fax:209-216-3365
Practice Address - Street 1:1801 COLORADO AVE
Practice Address - Street 2:STE 260
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2706
Practice Address - Country:US
Practice Address - Phone:209-216-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer