Healthcare Provider Details

I. General information

NPI: 1740029107
Provider Name (Legal Business Name): SON-ISHA COETZEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 01/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155
US

V. Phone/Fax

Practice location:
  • Phone: 800-432-6837
  • Fax: 305-669-6531
Mailing address:
  • Phone: 800-432-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: