Provider Demographics
NPI:1669954392
Name:DE AVILA, XOCHITL (COTA)
Entity type:Individual
Prefix:
First Name:XOCHITL
Middle Name:
Last Name:DE AVILA
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 ROMAN PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4572
Mailing Address - Country:US
Mailing Address - Phone:210-705-4426
Mailing Address - Fax:
Practice Address - Street 1:3018 ROMAN PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4572
Practice Address - Country:US
Practice Address - Phone:210-705-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211374224Z00000X
CA94028168390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program