Healthcare Provider Details

I. General information

NPI: 1992415368
Provider Name (Legal Business Name): JOAN ALVAREZ COTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE STE 52
HIALEAH FL
33012-7193
US

IV. Provider business mailing address

4410 W 16TH AVE STE 52
HIALEAH FL
33012-7193
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-9899
  • Fax:
Mailing address:
  • Phone: 305-825-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: