Provider Demographics
NPI:1548509383
Name:MOTA, JORGE ISMAEL JR (CADCA)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ISMAEL
Last Name:MOTA
Suffix:JR
Gender:M
Credentials:CADCA
Other - Prefix:MR
Other - First Name:JORGE
Other - Middle Name:ISMAEL
Other - Last Name:MOTA
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:JORGE MOTA
Mailing Address - Street 1:232 E GISH RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4706
Mailing Address - Country:US
Mailing Address - Phone:408-876-4284
Mailing Address - Fax:415-621-5466
Practice Address - Street 1:232 E GISH RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4706
Practice Address - Country:US
Practice Address - Phone:408-876-4284
Practice Address - Fax:415-621-5466
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2134OtherAC BHCS CLINICIAN# 00