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General NPI Number Information
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NPI Number | 1851107767
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Entity Type | Individual
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Provider Name | JUAN GUTIERREZ III COTA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 2590 TX-337 LOOP
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130
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Country | US
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Telephone | 830-620-0509
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Fax |
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Provider Business Mailing Address
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Address Line | 347 SONATA CYN
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City | SPRING BRANCH
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State | TX
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Zip | 78070-2265
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Country | US
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Telephone | 210-818-9242
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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 | 215794
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License Number State | TX
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