Healthcare Provider Details

I. General information

NPI: 1992246672
Provider Name (Legal Business Name): EVELYN GARCIA COELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 79TH AVE SUITE 116
DORAL FL
33122
US

IV. Provider business mailing address

2500 SW 79TH AVE SUITE 116
DORAL FL
33122
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-7898
  • Fax:
Mailing address:
  • Phone: 305-591-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: