Healthcare Provider Details

I. General information

NPI: 1750119426
Provider Name (Legal Business Name): FERNANDO CUADRADO-RIVERA COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36065 SANTA FE AVE
FORT CAVAZOS TX
76544-5060
US

IV. Provider business mailing address

36065 SANTA FE AVE
FORT CAVAZOS TX
76544-5060
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8030
  • Fax:
Mailing address:
  • Phone: 254-288-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number217194
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: