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General NPI Number Information
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NPI Number | 1386013084
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Entity Type | Individual
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Provider Name | LISSELOT T MESA COTA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 311 NE 8TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33030-4738
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Country | US
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Telephone | 305-248-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 11055 SW 161ST TER
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City | MIAMI
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State | FL
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Zip | 33157-2840
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Country | US
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Telephone | 305-984-6080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | OTA14395
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License Number State | FL
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