Provider Demographics
NPI:1790263002
Name:RENTERIA, ROLANDO JAVIER JR (COTA)
Entity Type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:JAVIER
Last Name:RENTERIA
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1708 RIO DE JANEIRO ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7619
Mailing Address - Country:US
Mailing Address - Phone:956-739-0116
Mailing Address - Fax:956-383-4979
Practice Address - Street 1:1100 W MINNESOTA RD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-0163
Practice Address - Country:US
Practice Address - Phone:956-601-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214163224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214163OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS