Healthcare Provider Details

I. General information

NPI: 1982422812
Provider Name (Legal Business Name): RONALD CULBERTSON COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD STE 120
SAN ANTONIO TX
78211-3773
US

IV. Provider business mailing address

14011 PERSIMMON CV
SAN ANTONIO TX
78245-4492
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-1785
  • Fax: 210-922-1782
Mailing address:
  • Phone: 937-430-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number218571
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: