Healthcare Provider Details

I. General information

NPI: 1821924549
Provider Name (Legal Business Name): YAMILDIS URQUIOLA OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20121 SW 104TH CT
CUTLER BAY FL
33189-1307
US

IV. Provider business mailing address

20121 SW 104TH CT
CUTLER BAY FL
33189-1307
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-6936
  • Fax: 305-402-2433
Mailing address:
  • Phone: 305-803-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number16323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: