Healthcare Provider Details

I. General information

NPI: 1780815225
Provider Name (Legal Business Name): AURA E CIFUENTES COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15339 NW 7TH ST
PEMBROKE PINES FL
33028-1841
US

IV. Provider business mailing address

15339 NW 7TH ST
PEMBROKE PINES FL
33028-1841
US

V. Phone/Fax

Practice location:
  • Phone: 954-839-4299
  • Fax:
Mailing address:
  • Phone: 954-839-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberOTA10393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: