Provider Demographics
NPI:1457825648
Name:ALVAREZ SERRANO, EDDY ROBERTO (COTA)
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:ROBERTO
Last Name:ALVAREZ SERRANO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24945 SW 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4319
Mailing Address - Country:US
Mailing Address - Phone:305-495-7429
Mailing Address - Fax:
Practice Address - Street 1:630 S 19TH ST
Practice Address - Street 2:
Practice Address - City:SLATON
Practice Address - State:TX
Practice Address - Zip Code:79364-4714
Practice Address - Country:US
Practice Address - Phone:806-828-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215573224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant