Provider Demographics
NPI:1215417928
Name:GONZALEZ, CRISELDA ANN (COTA)
Entity Type:Individual
Prefix:
First Name:CRISELDA
Middle Name:ANN
Last Name:GONZALEZ
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 1:901 E REDBUD AVE STE 5A
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4673
Mailing Address - Country:US
Mailing Address - Phone:956-353-9508
Mailing Address - Fax:866-610-1692
Practice Address - Street 1:901 E REDBUD AVE STE 5A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4673
Practice Address - Country:US
Practice Address - Phone:956-353-9508
Practice Address - Fax:866-610-1692
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214983224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant