Provider Demographics
NPI:1972373397
Name:MENDOZA, KAREN AZUCENA (COTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:AZUCENA
Last Name:MENDOZA
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 1:4162 JUDIVAN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3439
Mailing Address - Country:US
Mailing Address - Phone:210-574-5458
Mailing Address - Fax:
Practice Address - Street 1:12000 NETWORK BLVD # 105A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3344
Practice Address - Country:US
Practice Address - Phone:915-444-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217995224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant