Provider Demographics
NPI:1457980179
Name:PALOMARES, ANA NICOLE (COTA)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:NICOLE
Last Name:PALOMARES
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 1:533 S WARD DR
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-9455
Mailing Address - Country:US
Mailing Address - Phone:956-309-7655
Mailing Address - Fax:
Practice Address - Street 1:533 S WARD DR
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-9455
Practice Address - Country:US
Practice Address - Phone:956-309-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215965224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant