Healthcare Provider Details

I. General information

NPI: 1154257467
Provider Name (Legal Business Name): CAROLINA GAMEZ LOPEZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 SW 27TH AVE FL 2
MIAMI FL
33145-2547
US

IV. Provider business mailing address

15771 SW 106TH TER APT 102
MIAMI FL
33196-4236
US

V. Phone/Fax

Practice location:
  • Phone: 305-890-9691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA20607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: