Provider Demographics
NPI:1104327287
Name:GONZALEZ, JAVIER ALEJANDRO (COTA)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:ALEJANDRO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 DAVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0017
Mailing Address - Country:US
Mailing Address - Phone:956-222-1843
Mailing Address - Fax:
Practice Address - Street 1:800 E DOVE AVE STE E
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2263
Practice Address - Country:US
Practice Address - Phone:956-618-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212306224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant