Provider Demographics
NPI:1942780713
Name:GONZALEZ, MELVA ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MELVA
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:MELVA
Other - Middle Name:ANN
Other - Last Name:DE LA ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:PO BOX 1735
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-1735
Mailing Address - Country:US
Mailing Address - Phone:361-389-9214
Mailing Address - Fax:
Practice Address - Street 1:3130 S BRAHMA BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7257
Practice Address - Country:US
Practice Address - Phone:361-592-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211629224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant