Healthcare Provider Details

I. General information

NPI: 1124356209
Provider Name (Legal Business Name): EMILIO ESCOBAR JR. COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S BRYAN RD
MISSION TX
78572-6222
US

IV. Provider business mailing address

306 S BRYAN RD
MISSION TX
78572-6222
US

V. Phone/Fax

Practice location:
  • Phone: 956-585-3333
  • Fax: 956-585-3441
Mailing address:
  • Phone: 956-585-3333
  • Fax: 956-585-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number210278
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: