Healthcare Provider Details

I. General information

NPI: 1346488285
Provider Name (Legal Business Name): CANDIDA R UJUETA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 IH 10 W
SAN ANTONIO TX
78201-5159
US

IV. Provider business mailing address

19965 FM 3175
LYTLE TX
78052-3481
US

V. Phone/Fax

Practice location:
  • Phone: 210-731-1300
  • Fax: 210-731-1385
Mailing address:
  • Phone: 210-357-0335
  • Fax: 830-709-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number111258
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: