Provider Demographics
NPI:1588780258
Name:VERDUZCO, YOLANDA (OTR, CHT)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:VERDUZCO
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1634
Mailing Address - Country:US
Mailing Address - Phone:210-558-4263
Mailing Address - Fax:
Practice Address - Street 1:10555 CULEBRA RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3667
Practice Address - Country:US
Practice Address - Phone:210-888-6042
Practice Address - Fax:210-888-6045
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4509OtherBCBS
TX109642OtherOT STATE LICENSE
TX1252510001OtherMEDICARE NSC
TXQ24344OtherUPIN NUMBER
TX00774VMedicare PIN
TX1252510001OtherMEDICARE NSC
TXQ24344OtherUPIN NUMBER