Healthcare Provider Details

I. General information

NPI: 1134435993
Provider Name (Legal Business Name): DEBBIE PYLANT COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25014 COOPER VLY
SAN ANTONIO TX
78255-2319
US

IV. Provider business mailing address

25014 COOPER VLY
SAN ANTONIO TX
78255-2319
US

V. Phone/Fax

Practice location:
  • Phone: 318-267-1530
  • Fax:
Mailing address:
  • Phone: 318-267-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number210804
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: