Healthcare Provider Details

I. General information

NPI: 1699559021
Provider Name (Legal Business Name): PAIGE BUENROSTRO COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 CORONA DR
CORPUS CHRISTI TX
78411-4320
US

IV. Provider business mailing address

4646 CORONA DR
CORPUS CHRISTI TX
78411-4320
US

V. Phone/Fax

Practice location:
  • Phone: 361-204-3097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number216242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: