Provider Demographics
NPI:1356185557
Name:COTA, BROOKLYN TINNEAL
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:TINNEAL
Last Name:COTA
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 1:7874 BLACKHAWK CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-2445
Mailing Address - Country:US
Mailing Address - Phone:909-278-1332
Mailing Address - Fax:
Practice Address - Street 1:7874 BLACKHAWK CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-2445
Practice Address - Country:US
Practice Address - Phone:909-278-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician