Provider Demographics
NPI:1417394057
Name:VALDEZ, CONSUELO E (COTA)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:E
Last Name:VALDEZ
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 1:2010 W WESTERN DR APT 2
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3760
Mailing Address - Country:US
Mailing Address - Phone:956-821-2395
Mailing Address - Fax:
Practice Address - Street 1:2010 W WESTERN DR APT 2
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3760
Practice Address - Country:US
Practice Address - Phone:956-821-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211292224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant