Healthcare Provider Details

I. General information

NPI: 1356814917
Provider Name (Legal Business Name): ALEXSANDRA ESTRADA NIEVES COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PARK PLACE BLVD
KISSIMMEE FL
34741-2345
US

IV. Provider business mailing address

14701 TIMUCUA PL
CLERMONT FL
34711-6232
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-5063
  • Fax:
Mailing address:
  • Phone: 407-864-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number12991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: