Provider Demographics
NPI:1861074536
Name:GONZALEZ, ALMA B (COTA)
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:B
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N PECOS RD TRLR 41
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-4866
Mailing Address - Country:US
Mailing Address - Phone:702-423-9794
Mailing Address - Fax:
Practice Address - Street 1:100 DELMAR GARDENS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-3216
Practice Address - Country:US
Practice Address - Phone:702-361-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOTA-2345224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant