Provider Demographics
NPI:1831807361
Name:HERRERA, SERGIO (COTA/L)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 TONANTZIN PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3119
Mailing Address - Country:US
Mailing Address - Phone:972-922-5264
Mailing Address - Fax:
Practice Address - Street 1:1685 TONANTZIN PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3119
Practice Address - Country:US
Practice Address - Phone:972-922-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217198224Z00000X
NMOTA4672224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant