Basic Information
| Provider Information | |||||||||
| NPI: | 1831670033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SERNA | ||||||||
| FirstName: | DALIA | ||||||||
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| Credential: | COTA | ||||||||
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| OtherLastName: | CHAPA | ||||||||
| OtherFirstName: | DALIA | ||||||||
| OtherMiddleName: | SERNA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12701 WEST AVE APT 1126 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782161865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612320359 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6211 S NEW BRAUNFELS AVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782233175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105310569 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2018 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 212476 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.