Provider Demographics
NPI:1851836514
Name:GONZALEZ, ALEJANDRO (COTA)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
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 1:500 RUBIN DR APT 810
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5644
Mailing Address - Country:US
Mailing Address - Phone:915-274-1906
Mailing Address - Fax:
Practice Address - Street 1:500 RUBIN DR APT 810
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5644
Practice Address - Country:US
Practice Address - Phone:915-274-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214346224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant