Provider Demographics
NPI:1518604347
Name:DE LA GARZA, JOSE ALFREDO JR (COTA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ALFREDO
Last Name:DE LA GARZA
Suffix:JR
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 1:14111 VANCE JACKSON RD APT 4103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1982
Mailing Address - Country:US
Mailing Address - Phone:956-792-5372
Mailing Address - Fax:
Practice Address - Street 1:14111 VANCE JACKSON RD APT 4103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1982
Practice Address - Country:US
Practice Address - Phone:956-792-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX440309224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant