Provider Demographics
NPI:1306515424
Name:LOTA, JOSE MARIE M (NP)
Entity type:Individual
Prefix:MR
First Name:JOSE MARIE
Middle Name:M
Last Name:LOTA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:MILLENA
Other - Last Name:LOTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1055 SPRIG WAY
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-8157
Mailing Address - Country:US
Mailing Address - Phone:408-500-9503
Mailing Address - Fax:
Practice Address - Street 1:501 LIGHTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1439
Practice Address - Country:US
Practice Address - Phone:831-649-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily