Healthcare Provider Details

I. General information

NPI: 1881986891
Provider Name (Legal Business Name): YANEPSI COTELO-PARDO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 ALHAMBRA CIR 202
CORAL GABLES FL
33134-5106
US

IV. Provider business mailing address

2746 SW 131ST CT
MIAMI FL
33175-7184
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-3074
  • Fax: 844-270-7764
Mailing address:
  • Phone: 786-398-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN20131
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: