Healthcare Provider Details

I. General information

NPI: 1669561387
Provider Name (Legal Business Name): DEANNE J LUJAN I COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 WESTGATE BLVD C-301
AUSTIN TX
78745-1467
US

IV. Provider business mailing address

4701 WESTGATE BLVD C-301
AUSTIN TX
78745-1467
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-7900
  • Fax: 512-280-9298
Mailing address:
  • Phone: 512-892-7900
  • Fax: 512-280-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: