Healthcare Provider Details

I. General information

NPI: 1417445404
Provider Name (Legal Business Name): EDUARDO FERNANDEZ COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 SW 24TH ST STE 205
MIAMI FL
33155-2305
US

IV. Provider business mailing address

11066 SW 247TH TER
HOMESTEAD FL
33032-4693
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6868
  • Fax: 305-262-6867
Mailing address:
  • Phone: 305-321-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA16519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: