Provider Demographics
NPI:1487808689
Name:COTA, MANUEL JOSEPH (CNA-CMA)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:JOSEPH
Last Name:COTA
Suffix:
Gender:M
Credentials:CNA-CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4837
Mailing Address - Country:US
Mailing Address - Phone:701-572-6416
Mailing Address - Fax:
Practice Address - Street 1:514 10TH AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4837
Practice Address - Country:US
Practice Address - Phone:701-572-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND211533747P1801X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide