Provider Demographics
NPI:1649520552
Name:SILVA, JEANETTE MARIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:MARIE
Last Name:SILVA
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 1:705 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BOVINA
Mailing Address - State:TX
Mailing Address - Zip Code:79009
Mailing Address - Country:US
Mailing Address - Phone:575-693-7510
Mailing Address - Fax:
Practice Address - Street 1:705 9TH ST
Practice Address - Street 2:
Practice Address - City:BOVINA
Practice Address - State:TX
Practice Address - Zip Code:79009-0093
Practice Address - Country:US
Practice Address - Phone:575-693-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211762171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor