Healthcare Provider Details

I. General information

NPI: 1700368297
Provider Name (Legal Business Name): HASAYALI MEJIA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 N EXPRESSWAY 77, SUITE C
BROWNSVILLE TX
78526
US

IV. Provider business mailing address

1900 S JACKSON RD STE 2
MCALLEN TX
78503-1589
US

V. Phone/Fax

Practice location:
  • Phone: 965-350-6696
  • Fax: 956-350-6604
Mailing address:
  • Phone: 956-630-4400
  • Fax: 965-630-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number214785
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: