Provider Demographics
NPI:1053650358
Name:GARCIA, GRISELDA (COTA)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 JAIME ZAPATA MEMORIAL HWY STE A4
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-5010
Mailing Address - Country:US
Mailing Address - Phone:956-723-6700
Mailing Address - Fax:956-724-5599
Practice Address - Street 1:2805 FOUNTAIN PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8031
Practice Address - Country:US
Practice Address - Phone:956-316-2224
Practice Address - Fax:956-316-1717
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171436201Medicaid
TX171436201Medicaid