Provider Demographics
NPI:1801397898
Name:GONZALEZ, ANA MARIA (COTA)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:MARIA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:500 RUBIN DR APT 810
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5644
Mailing Address - Country:US
Mailing Address - Phone:915-820-2164
Mailing Address - Fax:
Practice Address - Street 1:500 RUBIN DR APT 810
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5644
Practice Address - Country:US
Practice Address - Phone:915-842-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212079224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant