Provider Demographics
NPI:1114672920
Name:COBIELLA MEDICAL GROUP
Entity Type:Organization
Organization Name:COBIELLA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDOLKA
Authorized Official - Middle Name:SULAY
Authorized Official - Last Name:COBIELLA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-905-1855
Mailing Address - Street 1:7221 CORAL WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1436
Mailing Address - Country:US
Mailing Address - Phone:305-905-1855
Mailing Address - Fax:
Practice Address - Street 1:7221 CORAL WAY STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1436
Practice Address - Country:US
Practice Address - Phone:305-905-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty