Provider Demographics
NPI:1013984558
Name:DELACOTERA HEALTH CARE ASSOCIATION
Entity Type:Organization
Organization Name:DELACOTERA HEALTH CARE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA COTERA JULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-248-8872
Mailing Address - Street 1:129 VISION PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3024
Mailing Address - Country:US
Mailing Address - Phone:281-248-8872
Mailing Address - Fax:281-248-8875
Practice Address - Street 1:129 VISION PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3024
Practice Address - Country:US
Practice Address - Phone:281-248-8872
Practice Address - Fax:281-248-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178522201Medicaid
TX178522201Medicaid