Provider Demographics
NPI:1043831746
Name:COTES, VLADIMIR ENRIQUE
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:ENRIQUE
Last Name:COTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16432 SW 53RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5181
Mailing Address - Country:US
Mailing Address - Phone:786-538-0620
Mailing Address - Fax:
Practice Address - Street 1:16432 SW 53RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5181
Practice Address - Country:US
Practice Address - Phone:786-538-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116038106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty