Healthcare Provider Details

I. General information

NPI: 1447921259
Provider Name (Legal Business Name): ANGELICA CORTINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 SW 72ND AVE STE 210
MIAMI FL
33155-5549
US

IV. Provider business mailing address

324 NW 152ND LN
PEMBROKE PINES FL
33028-1819
US

V. Phone/Fax

Practice location:
  • Phone: 305-461-4702
  • Fax:
Mailing address:
  • Phone: 786-721-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT22298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: