Provider Demographics
NPI:1821729328
Name:CARDOZA, MARY ANNE SAHAGUN (COTA)
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:SAHAGUN
Last Name:CARDOZA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14243 SHETLAND WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-4664
Mailing Address - Country:US
Mailing Address - Phone:949-371-7333
Mailing Address - Fax:
Practice Address - Street 1:14243 SHETLAND WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-4664
Practice Address - Country:US
Practice Address - Phone:949-371-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217395224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant