Healthcare Provider Details

I. General information

NPI: 1568177244
Provider Name (Legal Business Name): ALEXANDRA ALSTON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 SAN PEDRO AVE STE 305
SAN ANTONIO TX
78232-3739
US

IV. Provider business mailing address

16510 TWIN FOX
SAN ANTONIO TX
78247-1137
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 210-387-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: