Provider Demographics
NPI:1902622129
Name:COTA, KARLA MELISSA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:MELISSA
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 1:592 WENSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3955
Mailing Address - Country:US
Mailing Address - Phone:442-283-6035
Mailing Address - Fax:
Practice Address - Street 1:1802 N IMPERIAL AVE
Practice Address - Street 2:SUITE D130
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1325
Practice Address - Country:US
Practice Address - Phone:442-283-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW1445315106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician