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General NPI Number Information
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NPI Number | 1457825648
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Entity Type | Individual
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Provider Name | EDDY ROBERTO ALVAREZ SERRANO COTA
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Gender | Male
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 630 S 19TH ST
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City | SLATON
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State | TX
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Zip | 79364-4714
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Country | US
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Telephone | 806-828-7177
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Fax |
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Provider Business Mailing Address
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Address Line | 24945 SW 119TH AVE
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City | HOMESTEAD
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State | FL
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Zip | 33032-4319
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Country | US
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Telephone | 305-495-7429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 215573
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License Number State | TX
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