=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184082737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VEDA JEANETTE WOODS COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2016
-----------------------------------------------------
Last Update Date | 02/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20434 FAIRFIELD PARK WAY
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-414-5721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20434 FAIRFIELD PARK WAY
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-414-5721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | 210524
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------