Provider Demographics
NPI:1487253571
Name:COITO, ROXANNE RENE
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:RENE
Last Name:COITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVANS
Other - Middle Name:RENE
Other - Last Name:COITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 N JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3355 MISSION AVE STE 239
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1322
Practice Address - Country:US
Practice Address - Phone:760-462-5581
Practice Address - Fax:760-309-3867
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty