Healthcare Provider Details

I. General information

NPI: 1104092121
Provider Name (Legal Business Name): JUAN E. PEREZ COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number121433
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: