Provider Demographics
NPI:1811646128
Name:PREZAS, VICTORIA (OTA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PREZAS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3204 GOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-3711
Mailing Address - Country:US
Mailing Address - Phone:210-956-1510
Mailing Address - Fax:
Practice Address - Street 1:4207 GARDENDALE ST STE B-204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3182
Practice Address - Country:US
Practice Address - Phone:210-956-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214921224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant