MEDICARE: SERGIO HERRERA COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	217198	TX
2	224Z00000X	Occupational Therapy Assistant	OTA4672	NM

General Provider Information

NPI Number	:	1831807361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO HERRERA COTA/L

Provider Business Mailing Address
First Line	:	1685 TONANTZIN PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3119
Country	:	US
Telephone Number	:	972-922-5264
Fax Number	:

Provider Business Practice Location Address
First Line	:	1685 TONANTZIN PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3119
Country	:	US
Telephone Number	:	972-922-5264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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Directions to “ SERGIO HERRERA COTA/L” Practice Location

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