Healthcare Provider Details

I. General information

NPI: 1093241994
Provider Name (Legal Business Name): EILEEN DELAGARZA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10839 QUARRY PARK
SAN ANTONIO TX
78233
UM

IV. Provider business mailing address

338 BYRNES DR
SAN ANTONIO TX
78209-4906
US

V. Phone/Fax

Practice location:
  • Phone: 210-257-6260
  • Fax:
Mailing address:
  • Phone: 361-726-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number211827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: