Provider Demographics
NPI:1528548237
Name:IRACHETA, VICTOR (COTA)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:IRACHETA
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 1:3030 FIG ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3834
Mailing Address - Country:US
Mailing Address - Phone:361-888-5619
Mailing Address - Fax:361-888-5819
Practice Address - Street 1:3030 FIG ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3834
Practice Address - Country:US
Practice Address - Phone:361-888-5619
Practice Address - Fax:361-888-5819
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
TX210466224Z00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant