Healthcare Provider Details

I. General information

NPI: 1962613398
Provider Name (Legal Business Name): RAQUEL MARTINEZ C.O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8632 FREDRICKSBURG RD SUITE 212
SAN ANTONIO TX
78240
US

IV. Provider business mailing address

PO BOX 700391
SAN ANTONIO TX
78232
US

V. Phone/Fax

Practice location:
  • Phone: 210-696-5777
  • Fax: 505-468-9476
Mailing address:
  • Phone: 210-835-4541
  • Fax: 210-645-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number208537
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: